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Graft-Versus-Host Disease

Higher CD3+ and CD34+ cell doses in the graft increase the incidence of acute GVHD in children receiving BMT for thalassemia

Bone Marrow Transplantation volume 47, pages 107–114 (2012)Cite this article

Abstract

We evaluated the incidence of GVHD, risk factors and the impact of graft composition on acute GVHD (aGVHD) in 92 children who underwent BMT for thalassemia following busulfan/cyclophosphamide (BUCY)-based conditioning regimens and GVHD prophylaxis with CSA/short-MTX and methylprednisolone. The incidence of grade 2–4 and 3–4 aGVHD was 35% (95% confidence interval (CI) 25–44) and 9% (95% CI 4–16), respectively. We found that CD3+ and CD34+ cell doses above the median were associated with high incidence of grade 2–4 aGVHD (49 vs 20%, P=0.005 and 46 vs 23%, P=0.021, respectively). In multivariate analysis, high CD3+ (hazard ratio (HR) 4.6; 95% CI 1.4–14.7; P=0.010) and CD34+ (HR 4.3; 95% CI 1.4–12.7; P=0.011) cell doses were associated with grade 2–4 aGVHD. We further examined the effect of CD3+ and CD34+ cell doses on aGVHD using quartile cutoff points and found a minimum threshold for CD3+ (38 × 106/kg) and CD34+ (4 × 106/kg) cells above which the incidence of grade 2–4 aGVHD is significantly increased. This study shows for the first time a positive correlation between the number of CD3+ and CD34+ cells and aGVHD in children receiving sibling BMT, and indicates that using tailored and more intensive post transplant immunosuppression may permit to better control aGVHD.

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Acknowledgements

We thank all the patients and their families for their participation in this study, all the nurses for their dedicated care of patients, colleagues from Laboratorio di Immunogenetica e Biologia dei Trapianti and Antonella Santucci for statistical support.

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Authors and Affiliations

  1. International Center for Transplantation in Thalassemia and Sickle Cell Anemia, Mediterranean Institute of Hematology, Policlinico Tor Vergata, Rome, Italy

    J Gaziev, A Isgrò, M Marziali, C Gallucci, P Sodani, M D Simone, K Paciaroni, M Andreani, M Testi, G De Angelis, A Roveda, C Alfieri, F Saltarelli & G Lucarelli

  2. Servizio di Immunoematologia e Medicina Trasfusionale, Policlinico Tor Vergata, Rome, Italy

    N Daniele, G Adorno, A Lanti & G Del Proposto

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Correspondence to J Gaziev.

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Gaziev, J., Isgrò, A., Marziali, M. et al. Higher CD3+ and CD34+ cell doses in the graft increase the incidence of acute GVHD in children receiving BMT for thalassemia. Bone Marrow Transplant 47, 107–114 (2012). https://doi.org/10.1038/bmt.2011.3

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