Faculty Collaboration Database

Risk factors associated with increased nonrelapse mortality and with poor overall survival in children with chronic graft-versus-host disease. Blood 2011 Oct 20;118(16):4472-9

Date

09/01/2011

Pubmed ID

21878671

Pubmed Central ID

PMC3204914

DOI

10.1182/blood-2011-04-349068

Scopus ID

2-s2.0-80054832128 (requires institutional sign-in at Scopus site)   39 Citations

Abstract

There is a paucity of information regarding the factors that affect nonrelapse mortality (NRM) and overall survival among children that develop chronic graft-versus-host disease (cGVHD). We performed multivariate analyses using data from the Center for International Blood and Marrow Transplant Research to identify risk factors for NRM and survival in 1117 pediatric subjects with leukemia or myelodysplastic syndrome, transplanted from related donors, unrelated donors (URD), or unrelated cord blood between 1995 and 2004. We identified 4 variables associated with higher NRM: HLA partially matched or mismatched URD, peripheral blood cell graft, Karnofsky/Lansky score < 80 at cGVHD diagnosis, and platelets < 100 × 10(9)/L at cGVHD diagnosis. Factors associated with significantly worse survival were: age > 10 years, transplantation from HLA partially matched or mismatched URD, advanced disease at transplantation, Karnofsky/Lansky < 80; and platelets < 100 × 10(9)/L. Cumulative incidence of discontinuation of systemic immune suppression at 1, 3, and 5 years after diagnosis of cGVHD were 22% (20%-25%), 34% (31%-37%), and 37% (34%-40%), respectively. This is the largest study elucidating variables affecting outcome after diagnosis of cGVHD in pediatric allograft recipients. These variables may be useful for risk stratification, development of future clinical trials, and family counseling in children with cGVHD.

Author List

Jacobsohn DA, Arora M, Klein JP, Hassebroek A, Flowers ME, Cutler CS, Urbano-Ispizua A, Bolwell BJ, Antin JH, Boyiadzis M, Cahn JY, Cairo MS, Herzig RH, Isola LM, Klumpp TR, Lee SJ, Petersdorf EW, Santarone S, Gale RP, Schouten HC, Spellman SR, Weisdorf DJ, Wingard JR, Horowitz MM, Pavletic SZ

Author

Mary M. Horowitz MD, MS Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adolescent
Adult
Child
Child, Preschool
Chronic Disease
Female
Fetal Blood
Graft vs Host Disease
Humans
Infant
Infant, Newborn
Leukemia
Male
Myelodysplastic Syndromes
Retrospective Studies
Risk Factors
Survival Analysis
Young Adult