Acute and chronic graft-versus-host disease after ablative and nonmyeloablative conditioning for allogeneic hematopoietic transplantation

Daniel R. Couriel, Rima M. Saliba, Sergio Giralt, Issa Khouri, Borje Andersson, Marcos de Lima, Chitra Hosing, Paolo Anderlini, Michelle Donato, Karen Cleary, James Gajewski, Joyce Neumann, Cindy Ippoliti, Gabriela Rondon, Agueda Cohen, Richard Champlin

    Research output: Contribution to journalArticle

    157 Scopus citations

    Abstract

    In this study, we evaluated the influence of nonmyeloablative and ablative conditioning regimens on the occurrence of acute and chronic graft-versus-host disease (GVHD). One hundred thirty-seven patients undergoing matched-related sibling transplantations received the same GVHD prophylaxis. Myeloablative regimens included intravenous busulfan/cyclophosphamide (n = 45) and fludarabine/melphalan (n = 29). Patients in the nonmyeloablative group (n = 63) received fludarabine/idarubicin/cytarabine, cisplatin/fludarabine/idarubicin, and fludarabine/cyclophosphamide. The actuarial rate of grade II to IV acute GVHD was significantly higher (hazard ratio, 3.6; 95% confidence interval, 1.5-8.8) in patients receiving ablative regimens (36%) compared with the nonmyeloablative group (12%). The cumulative incidence of chronic GVHD was higher in the ablative group (40%) compared with the nonmyeloablative group (14%). The rates were comparable within the first 200 days and were significantly higher in the ablative group beyond day 200 (hazard ratio, 5.2; 95% confidence interval, 1.2-23.2). Nonrelapse and GVHD-related mortality were relatively low in both groups. The use of the described nonmyeloablative preparative regimens was associated with a reduced incidence of grade II to IV acute GVHD and chronic GVHD compared with the busulfan/cyclophosphamide and fludarabine/melphalan transplant regimens. It is interesting to note that nonrelapse mortality with nonmyeloablative regimens in older and more debilitated patients was low (14%) and comparable to that achieved with standard high-dose regimens in younger patients

    Original languageEnglish (US)
    Pages (from-to)178-185
    Number of pages8
    JournalBiology of Blood and Marrow Transplantation
    Volume10
    Issue number3
    DOIs
    StatePublished - Mar 1 2004

    Keywords

    • Acute GVHD
    • Preparative regimens

    ASJC Scopus subject areas

    • Hematology
    • Transplantation

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