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Graft-Versus-Host Disease

Serious graft-versus-host disease after hematopoietic cell transplantation following nonmyeloablative conditioning

Bone Marrow Transplantation volume 35, pages 277–282 (2005)Cite this article

An Erratum to this article was published on 23 February 2005

Summary:

The efficacy of allogeneic hematopoietic cell transplantation (HCT) after nonmyeloablative conditioning depends on the balance between the desirable antineoplastic effects of donor cells weighed against the undesirable morbidity of graft-versus-host disease (GVHD). Development of serious acute or chronic GVHD was analyzed retrospectively in 171 consecutive patients, who had related or unrelated nonmyeloablative HCT for hematologic malignancies. GVHD was defined as serious when it resulted in (1) death, (2) disability, (3) three or more major infections in 1 year, (4) prolonged hospitalization or (5) suicide or hospitalization for suicidal ideation. According to this definition, 43 of 171 (25%) patients developed serious GVHD with a median follow-up of 30 (range, 12–65) months. The incidence of serious GVHD was similar after related and unrelated HCT. Among the 43 patients with serious GVHD, 20 had grade III–IV acute GVHD, and 30 had extensive chronic GVHD. Among the 171 patients, seven had grade III acute GVHD and 84 had extensive chronic GVHD that did not meet criteria for serious GVHD. Assessment of serious GVHD provides additional useful information to acute GVHD grades and classification of limited and extensive chronic GVHD in describing the overall risk and impact complications caused by donor cells.

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Acknowledgements

We thank Judy Campbell, RN, Carina Moravec-ARNP, Heather Hooper, PA-C and the Long-Term Follow-Up staff at the Fred Hutchinson Cancer Research Center and the Seattle Cancer Care Alliance for their excellent care provided to our patients and families. We are also thankful for data assistance provided by the research nurses Steve Minor, Mary Hinds and John Sedgwick and the clinical trials coordinator Debbie Bassuk. We are grateful to our patients who participated in clinical trials and the referring physicians for their collaboration in our efforts to improve outcomes after allogeneic HCT.

Supported by PHS Grants HL36444, CA18221, CA78902, CA15704 and CA18029 from the National Institutes of Health, Department of Health and Human Services.

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Authors and Affiliations

  1. Division of Clinical Research, Fred Hutchinson Cancer Research Center and Department of Medicine, University of Washington, Seattle, WA, USA

    M E D Flowers, F Traina, B Storer, M Maris, W A Bethge, P Carpenter, F Appelbaum, R Storb, B M Sandmaier & P J Martin

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  1. M E D Flowers
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Correspondence to M E D Flowers.

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Flowers, M., Traina, F., Storer, B. et al. Serious graft-versus-host disease after hematopoietic cell transplantation following nonmyeloablative conditioning. Bone Marrow Transplant 35, 277–282 (2005). https://doi.org/10.1038/sj.bmt.1704767

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