Work

Acute GvHD Incidence and Outcome: Single Center Experience

Year: 2017

Type: article

Abstract: Acute graft vs host disease (aGvHD) remains a major cause of post-transplantation treatment-related mortality (TRM). aGvHD affects up to 50% of SCT recipients even with the administration of standard prophylactic immunosuppressive regimens; thus it remains an important post-transplantation complication, leading to high morbidity and mortality in allogeneic SCT recipients. Here we report our single center incidence of aGvHD from 2011-2013 in 148 patients with a median age of 8 years (range, .5-23 years) with: hematological disease (n = 28), acute leukemia (n = 58), MDS (n = 9), lymphoma (n = 15), HLH (n = 14), immunodeficiency (n = 22), EBV related lymphoproliferative disease (n = 1) and metabolic disorder (n = 1). Donors included 69 MUD/MMUD, 48 MRD/MMRD, 13 UCB, and 18 haplo. Campath was administered in most conditioning regimen (123/148). Sixty-one patients had aGvHD (41%) at a median time of 67 days (range, .5-18 m) after transplant with only 14% being severe aGVHD (21/148). Among the patients with aGvHD, twenty-one received a related donor matched or mismatched, MUD/MMUD (29), haplo (4), and UCB (7). aGvHD involved skin only for 38 pts, gut only for 3 pts, skin and liver for 9 pts, skin and gut 7 pts; skin, gut, and liver for 4 pts. Thirty-six patients developed stage II-IV aGvHD with 21 being stage III-IV aGVHD. 62% (13/21) of severe aGvHD was noted on the MUD/MMUD recipients. Overall survival of the whole cohort was 77% (115/148) with 78% (48/61) survival among the patients with aGvHD. The causes of death among the aGVHD patients were: GvHD (n = 3), pulmonary hemorrhage (n = 2), infection (n = 2), disease relapse (n = 3), and multi-organ failure (n = 3). In conclusion aGvHD is a common occurrence after pediatric SCT but only 13 patients developed severe grade III-IV which is possibly secondary to younger age and use of campath. Interestingly patients with aGvHD had similar overall survival when compared to patients without GvHD.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2016.12.455