TY - JOUR
T1 - Older recipient age is paradoxically associated with a lower incidence of chronic GVHD in Thymoglobulin recipients
T2 - A retrospective study exploring risk factors for GVHD in allogeneic transplantation with Thymoglobulin GVHD prophylaxis
AU - Lim, A. B.M.
AU - Storek, J.
AU - Beligaswatte, A.
AU - Collins, M.
AU - Tacey, M.
AU - Williamson, T.
AU - Mason, K.
AU - Li, E.
AU - Chaudhry, M. A.
AU - Russell, J. A.
AU - Daly, A.
AU - Szer, J.
AU - Lewis, I.
AU - Ritchie, D.
PY - 2015/2/2
Y1 - 2015/2/2
N2 - Thymoglobulin (TG) given with conditioning for allogeneic haematopoietic SCT (alloHSCT) is effective in reducing the risk of acute and chronic GVHD (cGVHD). Whether conventional risk factors for GVHD apply to TG-conditioned alloHSCT is unknown. We retrospectively studied 356 adults from three centres who received TG 4.5 mg/kg prior to alloHSCT for haematologic malignancy. Donors were unrelated in 64%. At 3 years, OS was 61% (95% confidence interval (CI) 55-67%), cumulative incidence of relapse was 28% (95% CI 23-33%) and non-relapse mortality was 19% (14-24%). The cumulative incidences of grade 2-4, and grade 3-4 acute GVHD were 23% (95% CI 19-28%) and 10% (95% CI 6-13%), respectively. The cumulative incidence of cGVHD requiring systemic immunosuppression (cGVHD-IS) at 3 years was 32% (95% CI 27-37%). On multivariate analysis, counterintuitively, recipient age over 40 was associated with a significantly decreased risk of cGVHD-IS (P=0.001). We report for the first time a paradoxical association of older age with reduced cGVHD in TG recipients, and conclude that traditional risk factors for GVHD may behave differently in the context of pre-transplant TG.
AB - Thymoglobulin (TG) given with conditioning for allogeneic haematopoietic SCT (alloHSCT) is effective in reducing the risk of acute and chronic GVHD (cGVHD). Whether conventional risk factors for GVHD apply to TG-conditioned alloHSCT is unknown. We retrospectively studied 356 adults from three centres who received TG 4.5 mg/kg prior to alloHSCT for haematologic malignancy. Donors were unrelated in 64%. At 3 years, OS was 61% (95% confidence interval (CI) 55-67%), cumulative incidence of relapse was 28% (95% CI 23-33%) and non-relapse mortality was 19% (14-24%). The cumulative incidences of grade 2-4, and grade 3-4 acute GVHD were 23% (95% CI 19-28%) and 10% (95% CI 6-13%), respectively. The cumulative incidence of cGVHD requiring systemic immunosuppression (cGVHD-IS) at 3 years was 32% (95% CI 27-37%). On multivariate analysis, counterintuitively, recipient age over 40 was associated with a significantly decreased risk of cGVHD-IS (P=0.001). We report for the first time a paradoxical association of older age with reduced cGVHD in TG recipients, and conclude that traditional risk factors for GVHD may behave differently in the context of pre-transplant TG.
KW - alloHSCT
KW - cGVHD
KW - cGVHD-IS
UR - http://www.scopus.com/inward/record.url?scp=84926419743&partnerID=8YFLogxK
U2 - 10.1038/bmt.2014.313
DO - 10.1038/bmt.2014.313
M3 - Article
C2 - 25642763
AN - SCOPUS:84926419743
VL - 50
SP - 566
EP - 572
JO - BONE MARROW TRANSPLANTATION
JF - BONE MARROW TRANSPLANTATION
SN - 0268-3369
ER -