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Risk factors for acute GVHD and survival after hematopoietic cell transplantation.

Abstract : Risk factors for acute GVHD (AGVHD), overall survival, and transplant-related mortality were evaluated in adults receiving allogeneic hematopoietic cell transplants (1999-2005) from HLA-identical sibling donors (SDs; n = 3191) or unrelated donors (URDs; n = 2370) and reported to the Center for International Blood and Marrow Transplant Research, Minneapolis, MN. To understand the impact of transplant regimen on AGVHD risk, 6 treatment categories were evaluated: (1) myeloablative conditioning (MA) with total body irradiation (TBI) + PBSCs, (2) MA + TBI + BM, (3) MA + nonTBI + PBSCs, (4) MA + nonTBI + BM, (5) reduced intensity conditioning (RIC) + PBSCs, and (6) RIC + BM. The cumulative incidences of grades B-D AGVHD were 39% (95% confidence interval [CI], 37%-41%) in the SD cohort and 59% (95% CI, 57%-61%) in the URD cohort. Patients receiving SD transplants with MA + nonTBI + BM and RIC + PBSCs had significantly lower risks of grades B-D AGVHD than patients in other treatment categories. Those receiving URD transplants with MA + TBI + BM, MA + nonTBI + BM, RIC + BM, or RIC + PBSCs had lower risks of grades B-D AGVHD than those in other treatment categories. The 5-year probabilities of survival were 46% (95% CI, 44%-49%) with SD transplants and 33% (95% CI, 31%-35%) with URD transplants. Conditioning intensity, TBI and graft source have a combined effect on risk of AGVHD that must be considered in deciding on a treatment strategy for individual patients.
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Contributor : Marie-Claire Dagher <>
Submitted on : Wednesday, July 31, 2013 - 4:21:54 PM
Last modification on : Tuesday, June 1, 2021 - 3:44:10 PM

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Madan Jagasia, Mukta Arora, Mary E D Flowers, Nelson J Chao, Philip L Mccarthy, et al.. Risk factors for acute GVHD and survival after hematopoietic cell transplantation.. Blood, American Society of Hematology, 2012, 119 (1), pp.296-307. ⟨10.1182/blood-2011-06-364265⟩. ⟨hal-00849704⟩



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