TRANSPLANTATION Risk Factors for Acute Graft - Versus - Host Disease After Allogeneic Blood Stem Cell

We evaluated demographic characteristics and graft composition as risk factors for acute graft-versus-host disease (GVHD) in 160 adult recipients of HLA-identical allogeneic blood stem cell transplants. The patients received a median nucleated cell dose of 7.9 3 108/kg and median C341 cell dose of 5.6 3 106/kg. GVHD prophylaxis consisted of cyclosporine (CSA) and steroids, tacrolimus (FK506) and steroids, or FK506 and methotrexate. Grades 2 to 4 GVHD occurred in 31% (95% CI, 23% to 39%), and grades 3 to 4 GVHD in 14% (95% CI, 8% to 20%). In univariate analyses, GVHD prophylaxis with CSA and high CD341 cell doses were significant risk factors for grades 2 to 4 GVHD, but diagnosis, age, use of total body irradiation, donor sex, female donor for male recipient, donor parity, donor alloimmunization, viral serology, nucleated cell dose, CD31 cell dose, and CD561 cell dose did not alter the incidence of GVHD significantly. With a CD341 cell dose less than 8 3 106 CD341 cells/kg, the risk of grades 2 to 4 GVHD was significantly higher for those who received CSA (39%, 95% CI, 21% to 47%) in comparison with those on FK506 (18%, 95% CI, 10% to 26%) (P 5 .03), but GVHD prophylaxis regimen had less impact with a higher CD341 cell dose (overall grades 2 to 4 GVHD rate 52%, 95% CI, 37% to 67%). GVHD prophylaxis and CD341 cell dose are independent risk factors for acute GVHD after allogeneic blood stem cell transplantation. r 1999 by The American Society of Hematology.