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Recipient and donor age impact the risk of developing chronic GvHD in children after allogeneic hematopoietic transplant

Bone Marrow Transplantation volume 52, pages 625–626 (2017)Cite this article

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The most recent large-scale pediatric publication evaluating risks of chronic GvHD (cGvHD) was published over 10 years ago.1 This study identified multiple risk factors for the development of cGvHD, but one of its limitations is that it predominantly included patients receiving HLA-identical related transplants (66%). The past decade has seen several important developments in the field, including the widespread adoption of the U.S. National Institute of Health’s (NIH) consensus diagnostic and staging criteria.2 An updated study evaluating risk factors for cGvHD in pediatric patients using the NIH consensus criteria in a population with a more diverse donor pool is needed to validate the results and could yield different risk factors.

In 2011, we published a study on risks of acute and cGvHD in 2941 children and adults who received allogeneic hematopoietic cell transplantation (HCT) following myeloablative conditioning for hematologic malignancies from 1992 through 2005 at the Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance.3 Utilizing the 2005 NIH consensus criteria,2 the 2-year cumulative incidence of moderate to severe cGvHD treated with systemic immunosuppression was 34% (95% confidence interval (CI), 32–35%). We identified seven risk factors for the development of cGvHD: HCT with HLA-matched unrelated donors (P<0.001), HCT with HLA-mismatched related donors (P=0.05), HCT with HLA-mismatched unrelated donors (P<0.001), all compared with HCT with HLA-matched related donors; the use of a female donor for a male recipient (P<0.001), utilization of mobilized blood cell grafts (P<0.001) and older donor and recipient age (P=0.006 and <0.001, respectively). A diagnosis of CML (P=0.04) was significantly associated with a decreased risk of cGvHD. Although our study included pediatric patients, the application of our results to the pediatric population is not apparent, because the median age was 40.3 (range, 0.6–71) years and patients <21 years of age represented only 15% of the total cohort.

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Acknowledgements

This work was supported in part by grants CA018029 at the National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Cancer Institute or the National Institutes of Health.

Author contributions

BKW analyzed data and wrote the paper; JH wrote the paper; BES performed the statistical analysis and reviewed the paper; PJM reviewed the paper; PAC reviewed the paper; and MEDF analyzed data and wrote the paper.

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Authors and Affiliations

  1. Aflac Cancer and Blood Disorders Center, Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA

    B K Watkins & J Horan

  2. Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    B Storer, P J Martin, P A Carpenter & M E D Flowers

  3. Department of Biostatistics, University of Washington School of Medicine, Seattle, WA, USA

    B Storer

  4. Department of Medicine, University of Washington School of Medicine, Seattle, WA, USA

    P J Martin & M E D Flowers

  5. Department of Pediatrics, University of Washington School of Medicine, Seattle, WA, USA

    P A Carpenter

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  1. B K Watkins
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  6. M E D Flowers
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Correspondence to M E D Flowers.

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Watkins, B., Horan, J., Storer, B. et al. Recipient and donor age impact the risk of developing chronic GvHD in children after allogeneic hematopoietic transplant. Bone Marrow Transplant 52, 625–626 (2017). https://doi.org/10.1038/bmt.2016.328

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