Clinical Impact of Hyperacute Graft-Versus-Host Disease on the Results of Allogeneic Stem Cell Transplantion. Session Type: Publication Only

Sang Kyun Sohn, Dong Hwan Kim, Jong Gwang Kim, Woo Jin Sung, Kang Woon Suh, Jang Soo Suh, Kun Soo Lee, Kyu Bo Lee

Author address: 

Dept. of Oncology/Hematology, Kyungpook National University Hospital, Daegu, Republic of Korea; Stem cell transplantation center, Kyungpook National University Hospital, Daegu, Republic of Korea

Abstract: 

Hyperacute GVHD (haGVHD) is a unique immunologic phenomenon during the pre-engraftment period after allogeneic stem cell transplantation (SCT), consisting of non-infectious fever, diarrhea, hepatic dysfunction and skin rash. Ninety patients (35 year old of median age, male 55, female 35) underwent allogeneic SCT from matched sibling (n=71; 59 PB, 12 BM) or alternative donors including matched unrelated or mismatched sibling donors (n=19; 7 PB, 12 BM). HaGVHD was diagnosed according to the following criteria: 1) unexplained fever for more than 3 days before engraftment with lack of resolution after treatment with broad-spectrum antibiotics (antifungal agents). 2) rapid development of skin rash before engraftment with exclusion of other causes. 3) hepatic dysfunction, especially alkaline phosphatase and bilirubin, before engraftment with exclusion of other causes. 4) the development of mucoid, greenish diarrhea with more than 5 stools/day with exclusion of mucositis. The diagnosis was supported by the resolution of above clinical findings with high-dose corticosteroids. The incidence of haGVHD was 36.7% (n=34) in overall allogeneic transplant patients, 30.9% in transplants using matched sibling donors, and 63.2% in transplants using alternative donors. A prompt response to steroids was documented in all 22 patients who were treated with high dose corticosteroids. Fever resolved within 24 hours in 18 cases (81.8%), diarrhea within 2 days in 64.7% of cases, hepatic dysfunction within 3 days in 63.6%, and skin lesions within 24 hours in 60.0%. In univariate analysis, the use of alternative donor (p=0.010) and the diagnosis of aplastic anemia (p=0.012) were identified as a risk factor. The use of alternative donor (p=0.02, hazard ratio 4.714 [C.I.,1.453,15.299]) was the only significant risk factor for the development of haGVHD in multivariate analysis. Other risk factors including non-myeloablative conditioning, stem cell source, MNC dose, and CD34+ cell dose were not associated with the development of haGVHD. HaGVHD was strongly correlated with acute (p
2003

abstract No: 

5509

Full conference title: 

American Society of Hematology 45th Annual Meeting
    • ASH 45th (2003)