Chronic Graft-Versus-Host Disease (cGVHD) following Unrelated Donor Hematopoietic Stem Cell Transplantation (HSCT): Higher Response Rate In Recipients of Unrelated Donor (URD) Umbilical Cord Blood (UCB)

Mukta Arora, Sriharsha Nagaraj, John E. Wagner, Juliet N. Barker, Claudio G. Brunstein, Linda J. Burns, Todd E. DeFor, Margaret L. McMillan, Jeffrey S. Miller, Daniel J. Weisdorf

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53 Scopus citations

Abstract

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 = .03] 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.

Original languageEnglish (US)
Pages (from-to)1145-1152
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume13
Issue number10
DOIs
StatePublished - Oct 2007

Bibliographical note

Funding Information:
This work was supported by grants from National Institutes of Health (NIH 1 P01-CA65493-01A8), Cord Blood Transplantation Study (COBLT Study: NO1-HB67139), T-Cell Depletion Trial (TCD trial: NO1-HB-47095), and Children’s Cancer Research Fund.

Keywords

  • Hematopoietic stem cell transplantation
  • Umbilical cord blood transplant
  • cGVHD

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