Journal
BIOLOGY OF BLOOD AND MARROW TRANSPLANTATION
Volume 13, Issue 10, Pages 1145-1152Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.bbmt.2007.06.004
Keywords
umbilical cord blood transplant; cGVHD; hematopoietic stem cell transplantation
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Funding
- NCI NIH HHS [P01 CA65493-01A8] Funding Source: Medline
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We present a comparative analysis of clinical presentation and response to treatment in 170 patients with chronic graft versus host disease (cGVHD) (123 following transplant from an unrelated donor [URD] and 47 from umbilical cord blood [UCB]). URD transplant recipients were significantly younger (median age 25 versus 39 years, P = .002; and the donor grafts were mostly HLA matched (67% versus 10%, P < .0001). UCB recipients had more frequent responses (complete remission [CR] + partial remission [PR]) to treatment (URD 48% versus UCB 74% at 2 months [P = .005]; 49% versus 78% at 6 months [P = .001] and 51% versus 72% at 1 year [P = .031 in the URD and UCB groups, respectively). Nonrelapse mortality (NRM) after diagnosis of cGVHD was worse after URD grafts. (1 year NRM 27% [19%-35%] URD versus 11% [2%-20%] UCB, P = .055). Separate multivariate analyses were performed in each cohort. In both, thrombocytopenia and no CR or PR at 2 months were independently associated with increased mortality. In addition, progressive onset of cGVHD was a significant predictor of increased mortality in URD cohort. These data suggest that cGVHD following UCB transplant may be more responsive to therapy and also lead to a lower NRM. (C) 2007 American Society for Blood and Marrow Transplantation.
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