Duration of immunosuppressive treatment for chronic graft-versus-host disease
Top Cited Papers
Open Access
- 1 December 2004
- journal article
- Published by American Society of Hematology in Blood
- Vol. 104 (12), 3501-3506
- https://doi.org/10.1182/blood-2004-01-0200
Abstract
Chronic graft-versus-host disease (GVHD) requires long-term immunosuppressive therapy after hematopoietic cell transplantation. We retrospectively analyzed a cohort of 751 patients with chronic GVHD to identify characteristics associated with the duration of immunosuppressive treatment. Among the 274 patients who discontinued immunosuppressive therapy after resolution of chronic GVHD before recurrent malignancy or death, the median duration of treatment was 23 months. Results of a multivariable model showed that treatment was prolonged in patients who received peripheral blood cells, in male patients with female donors, in those with graft-versus-host HLA mismatching, and in those with hyperbilirubinemia or multiple sites affected by chronic GHVD at the onset of the disease. Nonrelapse mortality was increased among patients with HLA mismatching or hyperbilirubinemia but not among those with other risk factors associated with prolonged treatment for chronic GVHD. Nonrelapse mortality was also increased in older patients and those with older donors, in patients with platelet counts less than 100 000/μL or progressive onset of chronic GVHD from acute GVHD, and in those receiving higher doses of prednisone immediately before the diagnosis of chronic GVHD. After the dose of prednisone was taken into account, progressive onset was not associated with an increased risk of nonrelapse mortality.This publication has 30 references indexed in Scilit:
- Female donors contribute to a selective graft-versus-leukemia effect in male recipients of HLA-matched, related hematopoietic stem cell transplantsBlood, 2004
- An update on how to treat chronic GVHDBlood, 2003
- Performance of a new clinical grading system for chronic graft-versus-host disease: a multicenter studyBlood, 2003
- Chronic graft-versus-host diseaseTransplantation and Cellular Therapy, 2003
- Chronic graft-versus-host disease: A prospective cohort studyTransplantation and Cellular Therapy, 2003
- Comparison of chronic graft-versus-host disease after transplantation of peripheral blood stem cells versus bone marrow in allogeneic recipients: long-term follow-up of a randomized trialBlood, 2002
- Immune reconstitution after allogeneic marrow transplantation compared with blood stem cell transplantationBlood, 2001
- Risk factors for chronic graft-versus-host disease after bone marrow transplantation: a retrospective single centre analysisBone Marrow Transplantation, 1998
- Summarizing data on survival, relapse, and chronic graft‐versus‐host disease after bone marrow transplantation: motivation for and description of new methodsBritish Journal of Haematology, 1993
- A EUROPEAN MULTICENTER STUDY OF CHRONIC GRAFT-VERSUS-HOST DISEASETransplantation, 1990