Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Letter to the Editor
  • Published:

High incidence of severe chronic GvHD after HSCT with sibling donors. A single center analysis

Bone Marrow Transplantation volume 51, pages 1518–1521 (2016)Cite this article

Subjects

For decades, HLA-identical sibling donor has been the gold standard for choice of donor. Many studies have compared HSCT using matched unrelated donors (URD) and HLA-identical sibling donors. Nowadays, the results of transplantation in these two groups are generally comparable. However, some studies have found a higher incidence of chronic GvHD when sibling donors were used, which is troublesome, as chronic GvHD in its most severe forms is potentially life-threatening and the factor most commonly associated with poor quality of life after HSCT.1 In this study we wanted to evaluate these two HSCT strategies: A) using sibling donors without anti-thymocyte globulin (ATG) and lower cyclosporine A (CsA) concentrations vs B) using URD including ATG and higher CsA concentrations for a longer time.

Furthermore, we wanted to determine the incidence, severity and risk factors for chronic GvHD after sibling donor and URD HSCT.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Figure 1

References

  1. Lee SJ, Klein JP, Barrett AJ, Ringden O, Antin JH, Cahn JY et al. Severity of chronic graft-versus-host disease: association with treatment-related mortality and relapse. Blood 2002; 100: 406–414.

    Article  CAS  PubMed  Google Scholar 

  2. Ringdén O, Horowitz M, Sondel P . Methotrexate,cyclosporine or both to prevent graft-versus-host disease after HLA-identical sibling bone marrow transplants for early leukemia. Blood 1993; 81: 1094–1101.

    PubMed  Google Scholar 

  3. Blennow O, Ljungman P, Sparrelid E, Mattsson J, Remberger M . Incidence, risk factors, and outcome of bloodstream infections during the pre-engraftment phase in 521 allogeneic hematopoietic stem cell transplantations. Transpl Infect Dis 2014; 16: 106–114.

    Article  CAS  PubMed  Google Scholar 

  4. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J et al. 1994 consensus conference on acute GvHD grading. (11Review) (11 refs). Bone Marrow Transplant 1995; 15: 825–828.

    CAS  PubMed  Google Scholar 

  5. Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ et al. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 2005; 11: 945–956.

    Article  PubMed  Google Scholar 

  6. Saber W, Opie S, Rizzo JD, Zhang MJ, Horowitz MM, Schriber J . Outcomes after matched unrelated donor versus identical sibling hematopoietic cell transplantation in adults with acute myelogenous leukemia. Blood 2012; 119: 3908–3916.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Yakoub-Agha I, Mesnil F, Kuentz M, Boiron JM, Ifrah N, Milpied N et al. Allogeneic marrow stem-cell transplantation from human leukocyte antigen-identical siblings versus human leukocyte antigen-allelic-matched unrelated donors (10/10) in patients with standard-risk hematologic malignancy: a prospective study from the French Society of Bone Marrow Transplantation and Cell Therapy. J Clin Oncol. 2006; 24: 5695–5702.

    Article  PubMed  Google Scholar 

  8. Remberger M, Svahn BM, Mattsson J, Ringden O . Dose study of thymoglobulin during conditioning for unrelated donor allogeneic stem-cell transplantation. Transplantation 2004; 78: 122–127.

    CAS  PubMed  Google Scholar 

  9. Finke J, Bethge WA, Schmoor C, Ottinger HD, Stelljes M, Zander AR et al. Standard graft- versus-host disease prophylaxis with or without anti-T-cell globulin in haematopoietic cell transplantation from matched unrelated donors: a randomised, open-label, multicentre phase 3 trial. Lancet Oncol 2009; 10: 855–864.

    Article  CAS  PubMed  Google Scholar 

  10. Kroger N, Solano C, Wolschke C, Bandini G, Patriarca F, Pini M et al. Antilymphocyte Globulin for Prevention of Chronic Graft-versus-Host Disease. N Engl J Med 2016; 374: 43–53.

    Article  PubMed  Google Scholar 

  11. Mohty M, Labopin M, Balere ML, Socie G, Milpied N, Tabrizi R et al. Antithymocyte globulins and chronic graft-vs-host disease after myeloablative allogeneic stem cell transplantation from HLA-matched unrelated donors: a report from the Societe Francaise de Greffe de Moelle et de Therapie Cellulaire. Leukemia 2010; 24: 1867–1874.

    Article  CAS  PubMed  Google Scholar 

  12. Walker I, Panzarella T, Couban S, Couture F, Devins G, Elemary M et al. Pretreatment with anti-thymocyte globulin versus no anti-thymocyte globulin in patients with haematological malignancies undergoing haemopoietic cell transplantation from unrelated donors: a randomised, controlled, open-label, phase 3, multicentre trial. Lancet Oncol 2015; 17: 164–173.

    Article  PubMed  Google Scholar 

  13. Bacigalupo A, Lamparelli T, Barisione G, Bruzzi P, Guidi S, Alessandrino PE et al. Thymoglobulin prevents chronic graft-versus-host disease, chronic lung dysfunction, and late transplant-related mortality: long-term follow-up of a randomized trial in patients undergoing unrelated donor transplantation. Biol Blood Marrow Transplant 2006; 12: 560–565.

    Article  PubMed  Google Scholar 

  14. Soiffer RJ, Lerademacher J, Ho V, Kan F, Artz A, Champlin RE et al. Impact of immune modulation with anti-T-cell antibodies on the outcome of reduced-intensity allogeneic hematopoietic stem cell transplantation for hematologic malignancies. Blood 2011; 117: 6963–6970.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Bacigalupo A, Lamparelli T, Bruzzi P, Guidi S, Alessandrino PE, di Bartolomeo P et al. Antithymocyte globulin for graft-versus-host disease prophylaxis in transplants from unrelated donors: 2 randomized studies from Gruppo Italiano Trapianti Midollo Osseo (GITMO). Blood 2001; 98: 2942–2947.

    Article  CAS  PubMed  Google Scholar 

  16. Duell T, van Lint MT, Ljungman P, Tichelli A, Socie G, Apperley JF et al. Health and functional status of long-term survivors of bone marrow transplantation. EBMT Working Party on Late Effects and EULEP Study Group on Late Effects. European Group for Blood and Marrow Transplantation. Ann Intern Med 1997; 126: 184–192.

    Article  CAS  PubMed  Google Scholar 

  17. Remberger M, Torlen J, Ringden O, Engstrom M, Watz E, Uhlin M et al. Effect of Total Nucleated and CD34(+) Cell Dose on Outcome after Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant 2015; 21: 889–893.

    Article  PubMed  Google Scholar 

  18. Mohty M, Bay JO, Faucher C, Choufi B, Bilger K, Tournilhac O et al. Graft-versus-host disease following allogeneic transplantation from HLA-identical sibling with antithymocyte globulin-based reduced-intensity preparative regimen. Blood 2003; 102: 470–476.

    Article  CAS  PubMed  Google Scholar 

  19. Blaise D, Kuentz M, Fortanier C, Bourhis JH, Milpied N, Sutton L et al. Randomized trial of bone marrow versus lenograstim-primed blood cell allogeneic transplantation in patients with early-stage leukemia: a report from the Societe Francaise de Greffe de Moelle. J Clin Oncol 2000; 18: 537–546.

    Article  CAS  PubMed  Google Scholar 

  20. Schmitz N, Bacigalupo A, Hasenclever D, Nagler A, Gluckman E, Clark P et al. Allogeneic bone marrow transplantation vs filgrastim-mobilised peripheral blood progenitor cell transplantation in patients with early leukaemia: first results of a randomised multicentre trial of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant 1998; 21: 995–1003.

    Article  CAS  PubMed  Google Scholar 

  21. Sahaf B, Yang Y, Arai S, Herzenberg LA, Herzenberg LA, Miklos DB . H-Y antigen-binding B cells develop in male recipients of female hematopoietic cells and associate with chronic graft vs. host disease. Proc Natl Acad Sci USA 2013; 110: 3005–3010.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Gratwohl A, Hermans J, Niederwieser D, van Biezen A, van Houwelingen HC, Apperley J . Female donors influence transplant-related mortality and relapse incidence in male recipients of sibling blood and marrow transplants. Hematol J 2001; 2: 363–370.

    Article  CAS  PubMed  Google Scholar 

  23. Lee SJ, Vogelsang G, Flowers ME . Chronic graft-versus-host disease. Biol Blood Marrow Transplant 2003; 9: 215–233.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by grants from the Swedish Cancer Society (CF2014-2016), the Swedish Children’s Cancer Foundation (PR2013-0022 and KF2013-0011), the Marianne and Marcus Wallenbergs Foundation (2013.0117) and grants provided by the Stockholm County Council (ALF-project 20140451).

Author information

Authors and Affiliations

  1. Center for Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden

    M Remberger, M Uhlin, J Mattsson & P Ljungman

  2. Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden

    M Remberger, M Uhlin & J Mattsson

  3. Department of Hematology, Karolinska University Hospital and Division of Hematology, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden

    G Afram, K LeBlanc, A Björklund & P Ljungman

  4. Karolinska University Hospital and Division of Pediatrics, Hematology/Immunology/SCT Section, Astrid Lindgren Children’s Hospital, CLINTEC, Stockholm, Sweden

    M Sundin

Authors
  1. M Remberger
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G Afram
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M Sundin
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M Uhlin
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. K LeBlanc
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. A Björklund
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J Mattsson
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. P Ljungman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to M Remberger.

Ethics declarations

Competing interests

The authors declare no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Remberger, M., Afram, G., Sundin, M. et al. High incidence of severe chronic GvHD after HSCT with sibling donors. A single center analysis. Bone Marrow Transplant 51, 1518–1521 (2016). https://doi.org/10.1038/bmt.2016.159

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/bmt.2016.159

Search

Advanced search

Quick links