THE DEVELOPMENT OF CHRONIC GRAFT-VERSUS-HOST DISEASE - AN ANALYSIS OFSCREENING STUDIES AND THE IMPACT OF CORTICOSTEROID USE AT 100 DAYS AFTER TRANSPLANTATION

The value of routine chronic graft-versus-host disease (GVHD) screenin g studies performed between 70 and 120 days after allogeneic marrow tr ansplantation was retrospectively evaluated among 241 patients. All pa tients received methotrexate and cyclosporine for GVHD prophylaxis and survived without relapse more than 4 months after transplant. Ninety- one patients (38%) developed clinical extensive chronic GVHD requiring systemic therapy. Data on patients who developed clinical extensive c hronic GVHD were compared with those on patients without chronic GVHD to determine which of the following screening tests predicted the subs equent development of clinical extensive chronic GVHD: skin biopsy, or al exam, lip biopsy, Schirmer's test, serum alkaline phosphatase, aspa rtate transaminase, immunoglobulin level and platelet count, In a univ ariable analysis, a positive or;ll examination and a low platelet coun t were predictive of chronic extensive GVHD development. In a multi va riable analysis which adjusted for the contribution of other chronic G VHD risk factors, such as age and a history of acute GVHD none of the screening tests were predictive of chronic GVHD development. The risk factors in this multivariable analysis which had the strongest associa tion with the development of chronic GVHD was a history of acute GVHD and use of corticosteroids at day 100 (RR = 3.9, P = 0.001), The use o f corticosteroids for acute GVHD at day 100 had a predictive effect on chronic GVHD development independent of the grade of acute GVHD (RR = 2.1, P = 0.004), Based on these study results, the use of chronic GVH D screening tests may not be of value in predicting who mill develop t his complication. Patients on corticosteroids at day 100 should be con sidered for clinical trials to determine the efficacy of new immunosup pressive agents in preventing chronic GVHD.