Chronic Graft-Versus-Host Disease after Allogenaic Bone Marrow Transplantation in Japan: Identification of Risk Factors and Prognostication.

Objective: Chronic graft-versus-host disease (cGVHD) is an important complication of allogeneic hematopoietic stem cell transplantation (HSCT) involving various organs such as skin, eyes, mouth, liver, lung, and gastrointestinal tract, which is associated with major disability and diminished quality of life. There have been several studies to explore risk and prognostic factors in Western countries. However, because the genetic homogeneity is different among the ethnics, such models are not assured to be applicable for Japanese patients. To identify the incidence and risk factors of cGVHD, and prognostic factors for patients who developed cGVHD, we analyzed a series of patients.

Methods: The incidence and prognostic factors for cGVHD were evaluated for 255 patients who survived more than 100 days after bone marrow transplantation (BMT) in Nagoya BMT Group.

Results: One hundred and nineteen (47%) developed cGVHD. Prior acute GVHD (grade 2–4) and use of unrelated donor were significantly associated with the onset of cGVHD. Systemic immunosuppressive therapies were administered to 86 patients (78%), 42 (38%) of whom required secondary therapies. Presence of cGVHD did not have an impact on mortality (hazard ratio [HR]=0.89; 95% confidence interval [CI], 0.59–1.3). Proposed prognostic models from Western countries, Akpek’s score and Lee’s grading system did not successfully classify our patients. Three factors at diagnosis were associated with cGVHD-specific survival; i.e. presence of infection (HR=4.1; 95%CI, 1.6–10.3), ongoing use of corticosteroid at the onset of cGVHD (HR=3.9; 95%CI, 1.7–9.1), and a Karnofsky performance score<80 (HR=4.7; 95%CI, 2.0–11.3). The probability of cGVHD-specific survival at 4 years was 79% (95%CI, 70–86%).

Conclusion: The severity and death rate of Japanese patients with cGVHD was lower than those for populations in Western countries, which might be the result of greater genetic homogeneity of Japanese ethnics. For prognostication, a different model was needed to identify high-risk patients.