RISK-FACTORS FOR CHRONIC GRAFT-VERSUS-HOST DISEASE AFTER BONE-MARROW TRANSPLANTATION - A RETROSPECTIVE SINGLE-CENTER ANALYSIS

Among 551 consecutive recipients of allogeneic bone marrow transplants , 451 survived more than 3 months and were evaluated for chronic graft -versus-host disease (GVHD), Most of the donors were HLA-identical sib lings or parents (n = 334), Patients with HLA-mismatched donors (n = 3 0) and matched unrelated donors (MUD) (n = 87) were also included in t he study. In the analysis of all patients, the 5-year cumulative incid ence of chronic GVHD was 45%, We analysed 34 risk factors. High recipi ent age was the single most important risk factor (P < 0.001), Other s ignificant risk factors in multivariate analysis were: acute GVHD grad es I-IV (P < 0.001), immune female donor to male recipient (P = 0.006) and chronic myelogenous leukaemia (CML), compared with all other diag noses (P = 0.014), The cumulative 5-year incidence of chronic GVHD, wi th no significant risk factors present, was 9%, 29% with one risk fact or, 53% with two, 68% with three and 75% with all four risk factors pr esent. In patients with HLA-identical sibling donors and GVHD prophyla xis consisting of a combination of methotrexate (MTX) and cyclosporin A (CsA) (n = 208), increasing recipient age (P < 0.001) and CML (P = 0 .007), were found to be significant risk factors for chronic GVHD, Fin ally, a multivariate analysis in recipients of bone marrow from unrela ted donors (n = 89) showed recipient age alone (P = 0.006) to be signi ficantly associated with chronic GVHD.