Predictors of death from chronic graft-versus-host disease after bone marrow transplantation

J. R. Wingard, S. Piantadosi, G. B. Vogelsang, E. R. Farmer, D. A. Jabs, L. S. Levin, W. E. Beschorner, R. A. Cahill, D. F. Miller, D. Harrison, R. Saral, G. W. Santos

Research output: Contribution to journalArticle

Abstract

Chronic graft-v-host disease (chronic GVHD) is a frequent cause of late morbidity and death after bone marrow transplantation (BMT). The actuarial survival after onset of chronic GVHD in 85 patients was 42% (95% CI = 29%, 54%) at 10 years. Baseline characteristics present at the onset of chronic GVHD (before therapy) in 85 patients were reviewed to determine which were risk factors for death. In a multivariate proportional hazards analysis, three baseline factors emerged as independent predictors of death: progressive presentation (chronic GVHD following acute GVHD without resolution of acute GVHD; hazard ratio of 4.1, 95% CI = 2.1 to 7.8), lichenoid changes on skin histology (hazard ratio of 2.2, 95% CI = 1.1 to 4.3), and elevation of serum bilirubin > 1.2 mg/dL (hazard ratio = 2.1, 95% CI = 1.1 to 4.1). Actuarial survival of 23 chronic GVHD patients with none of these risk factors was 70% at 6 years (95% CI = 38%, 88%). Thirty-eight patients with one of these risk factors had a projected 6-year survival of 43% (95% CI = 21%, 63%). The 29 patients with any combination of two or more of these factors had a projected 6-year survival of only 20% (95% CI = 8%, 37%). Identification of baseline risk factors should facilitate design of trials of chronic GVHD therapies and assignment of high-risk patients to more aggressive innovative therapeutic regimens.

Original languageEnglish (US)
Pages (from-to)1428-1435
Number of pages8
JournalBlood
Volume74
Issue number4
DOIs
StatePublished - 1989

ASJC Scopus subject areas

  • Biochemistry
  • Immunology
  • Hematology
  • Cell Biology

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    Wingard, J. R., Piantadosi, S., Vogelsang, G. B., Farmer, E. R., Jabs, D. A., Levin, L. S., Beschorner, W. E., Cahill, R. A., Miller, D. F., Harrison, D., Saral, R., & Santos, G. W. (1989). Predictors of death from chronic graft-versus-host disease after bone marrow transplantation. Blood, 74(4), 1428-1435. https://doi.org/10.1182/blood.v74.4.1428.bloodjournal7441428