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Long-Term Follow-Up of High-Risk Allogeneic Peripheral-Blood Stem-Cell Transplant Recipients: Graft-Versus-Host Disease and Transplant-Related Mortality

From the Department of Internal Medicine, Division of Bone Marrow Transplantation and Stem Cell Biology, Washington University School of Medicine, St. Louis, MO.

Address reprint requests to Randy A. Brown, MD, Washington University School of Medicine, 660 South Euclid, Box 8007, St. Louis, MO 63110; email rbrown{at}im.wustl.edu

PURPOSE: To determine the risks of graft-versus-host disease (GVHD) and transplant-related mortality after allogeneic peripheral-blood stem-cell (PBSC) transplantation.

PATIENTS AND METHODS: Between December 1994 and July 1996, 50 consecutive patients with high-risk hematologic malignancies in first remission or relapse received high-dose therapy followed by transplantation of granulocyte colony-stimulating factor–mobilized, allogeneic PBSCs collected from HLA-identical siblings. GVHD prophylaxis included cyclosporine and corticosteroids.

RESULTS: As of April 1, 1998, 18 patients (36% ± 13%) survived with a median follow-up period of 767 days (range, 602 to 1,127 days). The actuarial probability of grades 2-4 acute GVHD was 0.37 ± 0.14 (95% confidence interval). Of 36 assessable patients, 26 (72% ± 15%) developed chronic GVHD. The actuarial probability of chronic GVHD 2 years after transplantation was 0.87 ± 0.15. Of 14 progression-free survivors, 11 (79% ± 22%) have active, chronic GVHD. All 11 patients require ongoing immunosuppression, and nearly two thirds have extensive disease. Thirteen patients died as a result of transplant-related mortality (26% ± 12%), six (12%) before and seven (14%) after day +100.

CONCLUSION: We observed a high risk of chronic GVHD after allogeneic PBSC transplantation, which compromised the performance status of most long-term survivors and resulted in a relatively high risk of late transplant-related mortality. Approximately 75% of transplant-related deaths were associated with GVHD; thus, reduction in transplant-related mortality after allogeneic PBSC transplantation will require more effective strategies for the prophylaxis and/or treatment of GVHD.

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