Clinical Features Of Chronic Graft-versus-host Disease And The Impact On Outcome

Objective:To analysis the clinical features, risk factors and impact on outcome of chronic graft versus host disease(cGVHD)in related HLA2-3 antigen-mismatched (haploidentical)non T cell-depleted in vitro peripheral hematopoietic stem cell transp lantation(RHNT-PBSCT).Methods:A total of 83 patients who underwent the RHNT-PBSCT and surviving until day 100 posttransplant from Jan 1st,2006 to Jun 30th,2013 in our center, were retrospectively analyzed.The incidence, classifications and main clinical manifestations were estimated, and compared with those of the 60 patients who received the HLA-matched sibling non T cell-depleted in vitro PBSCT(MSNT-PBSCT)in the same period.Results:①The cumulative incidence of cGVHD had no significant difference between the two groups[65.9%(95%CI,55%-76.8%) versus 69.7%(95%CI,57.7%-81.7%), P>0.05]; but the cumulative incidence of limited cGVHD and extensive cGVHD both had significant difference between the two groups[50.9%(95%CI,39.3%-62.5%) versus 35.3% (95%CI,24.2%-48.8%), P=0.026]; [15.6%(95%CI,7.4%-23.8%) versus 37.9%(95%CI, 25.0%-50.8%), P=0.006].②In RHNT-PBSCT group, the most common sites involved were skin(56.9%)>liver(20.7%)>mouth(17.2%)>eye(3.4%)>nervous system(1.7%); while in MSNT-PBSCT group, the order was liver(34.5%)>skin(29.1%)>mouth(21.8%)>eye (7.3%)>gastrointestinal tract(3.6%)=muscle and joints(3.6%). ③Multivariate analysis showed that aGVHD was the only risk factor for either cGVHD or extensive cGVHD; while HLA-haploidentical PBSCT was associated with a reduced risk of extensive chronic GVHD.④analysis about prognosis show that the cumulative relapse rate(RR)of patients with cGVHD was significantly lower than those without, however, the overall survival(OS), disease-free survival(DFS)and transplantation-related mortality(TRM)had no significant difference; when compare the impact on outcome, no significant difference had been observed between two subtype cGVHD.Conclusion:The cumulative incidence of cGVHD in RHNT-PSCT group was not higher than MSNT-PBSCT group, and the incidence of extensive cGVHD was lower, most patients showed a involvement of skin or liver or mouth, all these indicate that RHNT-PBSCT protocol is feasible. Prevention of aGVHD maybe reduce the incidence of severe cGVHD; cGVHD is associated with lower RR to some extent.