Rationale: Serious manifestations of chronic graft-versus-host disease (cGVHC ) include scleroderma-like skin changes. There is a clinical suspicion that its incidence rniglt be higher after blood (BSCT) rather than marrow (BMT) transplantation. Objective: To determine incidence, risk factors, and outcome of sclerodermatoi s skin cGVHD (S-GVHD) after allogeneic stem cell transplantation (alloSCT). Methods: The records of 149 consecutive patients (pts) with hématologie-4! malignancies who survived 100 days after G-CSF mobilized 6/6 antigen matched relatecl alloSCT (63 BMT, 86 BSCT) were analyzed for the incidence of S-GVHD, defined a|s localized or diffuse skin thickening. All pts received identical GVHD prophylaxis will cyclosporine and methotrexate and 91% received a 1200 cGy TBl-containing preparativî regimen. Front-line cGVHD therapy consisted of cyclosporine and prednisone. Variables analyzed as risk factors for S-GVHD included: pts age and gender, type of malignancy, cytomegalovirus status, donor-recipient gender, stem cell source, TBI or etoposide in the preparative regimen, and acute GVHD (aGVHD). Results: The median follow-up of 82 surviving pts is 43 months (range, 12 to 108 months). Cumulative incidence of skin cGVHD was 60% (91 pts), 28% localized, 32 diffuse. The incidence of S-GVHD was 24% (36 pts), 23β6 (66%) had diffuse ski[i involvement. Prior history of skin aGVHD was the only variable significantly related to the incidence of S-GVHD (p=0.04). Higher stage of skin aGVHD was associated with increasing incidence of S-GVHD (p=0.011 for trend). In contrast, prior lower or upper GI or liver aGVHD (p=0.66, 1.0, and 0.70 respectively), or type of stem cell source (p=0.44) were non predictive for the onset of S-GVHD. Development of S-GVHD was associated with pts who had longer survival, median survival 62 months vs. 38 months (p=0.063). Conclusions: Prior history and clinical stage of aGVHD predict onset of S-GVHD. The incidence of S-GVHD seems to be independent of the stem cell source used for the alloSCT.
|Original language||English (US)|
|Issue number||11 PART I|
|State||Published - 2000|
ASJC Scopus subject areas
- Cell Biology