HIGH-INCIDENCE OF CHRONIC GRAFT-VERSUS-HOST DISEASE AFTER ALLOGENEIC PERIPHERAL-BLOOD PROGENITOR-CELL TRANSPLANTATION

Background and Objective. The incidence of acute GVHD (aGVHD) in allog eneic peripheral blood progenitor cell transplantation (allo-PBPCT) se ems to be similar to that seen in allogeneic bone marrow transplantati on (allo-BMT). In contrast, some preliminary results suggest that the incidence of chronic GVHD (cGVHD) might be higher. The aim of the pres ent study was to analyze the actuarial probability of developing cGVHD In allo-PBPCT, its clinical manifestations and response to treatment. Methods. We have retrospectively analyzed clinical results from 21 al lo-PBPCT recipients that had been transplanted at least 18 months befo re this study and that fulfilled the following criteria: HLA identical sibling donor, non T-cell depleted apheresis and more than 90 days of survival with sustained engraftment. The median follow-up was 12 mont hs (range 4.5-22). Results. Twelve out of the 21 (57%) patients presen ted cGVHD, 1 limited and 11 extensive. The actuarial probability of cG VHD was 72.7% (95% CI, 49-96%). The median interval from transplant to onset was 180 days (range 95-270). Nine of the 12 cases (75%) present ed combined skin and liver involvement. Of the other three, the liver was involved in one case; skin, mouth, and nail cGVHD was observed in another case; and skin and mouth involvement together with an obstruct ive pulmonary disease was observed in the remaining case. Under therap y, a complete resolution of cGVHD manifestations was achieved in five cases, and a partial improvement was attained in three other cases. In two responsive patients, cGVHD reappeared after stopping treatment. F our patients were refractory to the treatment. Interpretation and Conc lusions. It would appear from this retrospective and multicenter study that, after a median follow-up of 12 months, cGVHD after allo-PBPCT c ould be more frequent than after allo-BMT. A randomized trial with a l arge number of patients and a sufficient follow-up will be necessary t o answer this question definitively. (C) 1997, Ferrata Storti Foundati on.