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Graft-Versus-Host Disease

Older recipient age is paradoxically associated with a lower incidence of chronic GVHD in Thymoglobulin recipients: a retrospective study exploring risk factors for GVHD in allogeneic transplantation with Thymoglobulin GVHD prophylaxis

Bone Marrow Transplantation volume 50, pages 566–572 (2015)Cite this article

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Abstract

Thymoglobulin (TG) given with conditioning for allogeneic haematopoietic SCT (alloHSCT) is effective in reducing the risk of acute and chronic GVHD (cGVHD). Whether conventional risk factors for GVHD apply to TG-conditioned alloHSCT is unknown. We retrospectively studied 356 adults from three centres who received TG 4.5 mg/kg prior to alloHSCT for haematologic malignancy. Donors were unrelated in 64%. At 3 years, OS was 61% (95% confidence interval (CI) 55–67%), cumulative incidence of relapse was 28% (95% CI 23–33%) and non-relapse mortality was 19% (14–24%). The cumulative incidences of grade 2–4, and grade 3–4 acute GVHD were 23% (95% CI 19–28%) and 10% (95% CI 6–13%), respectively. The cumulative incidence of cGVHD requiring systemic immunosuppression (cGVHD-IS) at 3 years was 32% (95% CI 27–37%). On multivariate analysis, counterintuitively, recipient age over 40 was associated with a significantly decreased risk of cGVHD-IS (P=0.001). We report for the first time a paradoxical association of older age with reduced cGVHD in TG recipients, and conclude that traditional risk factors for GVHD may behave differently in the context of pre-transplant TG.

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Acknowledgements

We wish to acknowledge the staff and patients of the University of Calgary, Royal Adelaide Hospital and Royal Melbourne Hospital bone marrow transplant programmes. In addition, We acknowledge Mark Tacey, statistician, Melbourne EpiCentre, for additional statistical advice. Sanofi Australia Pty Ltd has provided funding to the Royal Melbourne Hospital for previous clinical studies involving the use of Thymoglobulin.

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This company was not involved in the design, collection, analysis or interpretation of this study, but they were given the opportunity to review this abstract prior to submission. The decision to submit for publication was made by the authors independently.

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Authors and Affiliations

  1. Department of Clinical Haematology & Bone Marrow Transplant Service, The Royal Melbourne Hospital, Parkville, Victoria, Australia

    A B M Lim, K Mason, E Li, J Szer & D Ritchie

  2. Department of Medicine, University of Melbourne, Parkville, Victoria, Australia

    A B M Lim, J Szer & D Ritchie

  3. Department of Oncology, University of Calgary, Calgary, Alberta, Canada

    J Storek, T Williamson, M A Chaudhry, J A Russell & A Daly

  4. Department of Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia

    A Beligaswatte & I Lewis

  5. Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia

    M Collins

  6. Melbourne EpiCentre, Parkville, Victoria, Australia

    M Tacey

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  1. A B M Lim
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Lim, A., Storek, J., Beligaswatte, A. et al. Older recipient age is paradoxically associated with a lower incidence of chronic GVHD in Thymoglobulin recipients: a retrospective study exploring risk factors for GVHD in allogeneic transplantation with Thymoglobulin GVHD prophylaxis. Bone Marrow Transplant 50, 566–572 (2015). https://doi.org/10.1038/bmt.2014.313

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