1. ¹Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Tsurumai-cho, Showa-ku, Nagoya, Japan
2. ²Division of Molecular Medicine, Aichi Cancer Center, Nagoya, Japan
3. ³Division of Hematology, Japan Red Cross Nagoya First Hospital, Nagoya, Japan
4. ⁴Department of Hematology, Meitetsu Hospital, Nagoya, Japan
5. ⁵Division of Hematology and Oncology, JA Aichi Showa Hospital, Konan, Japan
6. ⁶Department of Molecular Medicine and Hematology, Nagoya University Graduate School of Medicine, Nagoya, Japan
7. ⁷Division of Infectious Diseases, Hamamatsu Medical Center, Hamamatsu, Japan
8. ⁸Internal Medicine and Molecular Science, Nagoya City University Graduate School of Medical Sciences, Hamamatsu, Japan
9. ⁹Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
10. ¹⁰Clinical Research Center, Nagoya Medical Center, Nagoya, Japan

Correspondence: Dr Y Atsuta, Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. E-mail: y-atusta@med.nagoya-u.ac.jp

Received 9 May 2005; Revised 1 November 2005; Accepted 8 November 2005; Published online 9 January 2006.

Abstract

The incidence and prognostic factors for chronic graft-versus-host disease (cGVHD) were evaluated for 255 Japanese patients who survived more than 100 days after bone marrow transplantation, and of whom 119 (47%) developed cGVHD. Prior acute GVHD (grade 2–4) and use of an unrelated donor were significantly associated with the onset of cGVHD. Presence of cGVHD did not have an impact on mortality (hazard ratio (HR)=0.89; 95% confidence interval (CI), 0.59–1.3). Three factors at diagnosis were associated with cGVHD-specific survival: presence of infection (HR=4.1; 95% CI, 1.6–10.3), continuing use of corticosteroids at the onset of cGVHD (HR=3.9; 95% CI, 1.7–9.1), and a Karnofsky performance score <80 (HR=4.7; 95% CI, 2.0–11.3). The probability of cGVHD-specific survival at 4 years was 79% (95% CI, 70–86%). The severity and death rate of Japanese patients with cGVHD was lower than those for populations in Western countries, which might be the result of greater genetic homogeneity of Japanese ethnics. Our patients could not be accurately classified when the proposed prognostic models from Western countries were used, thus indicating the need for a different model to identify high-risk patients.