450 High Donor and Recipient Age Are Not Risk Factors for Chronic Graft-Versus-Host Disease in the Setting of Anti-Thymocyte Globulin-Conditioned Hematopoietic Stem Cell Transplantation

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Andrew Boon Ming Lim, MBBS FRACP FRCPA , Clinical Haematology & Bone Marrow Transplant Service, Royal Melbourne Hospital, Parkville, Australia
Jan Storek, MD, PhD , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Ashanka Beligaswatte , Department of Haematology, Royal Adelaide Hospital, Adelaide, Australia
Marnie Collins , Centre for Biostatistics and Clinical Trials, East Melbourne, Australia
Kate Mason , Royal Melbourne Hospital, Parkville, Victoria, Australia
Emily Peizhen Li, Master Degree in Cancer Nursing , Royal Melbourne Hospital, Parkville, Australia
Ahsan Chaudhry , Alberta Blood and Marrow Transplant Program, Calgary, AB, Canada
James A Russell, MA, MB , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Andrew Daly , Blood and Bone Marrow Transplant Program, Tom Baker Cancer Centre/Foothills Hospital, Calgary, AB, Canada
Jeffrey Szer, MB BS FRACP , Clinical Haematology & BMT Service, Royal Melbourne Hospital, Parkville, ., Australia
Ian Lewis, MBBS, PhD , Haematology, Royal Adelaide Hospital, Adelaide, SA, Australia
David Stuart Ritchie, MD, PhD , Peter MacCallum Cancer Centre, East Melbourne, Australia
Rabbit anti-thymocyte globulin (ATG) given with conditioning for allogeneic haematopoietic stem cell transplantation (alloHSCT) is effective in reducing the risk of chronic graft-versus-host disease (cGVHD). Whether conventional risk factors for cGVHD apply to ATG-conditioned alloHSCT is not known. Between the years 2004 and 2011, 356 adults (median age 48) from 3 centres received 4.5 mg/kg of Thymoglobulin prior to alloHSCT for haematologic malignancy (acute leukaemia 58%, chronic myeloid leukaemia 6%, other myeloid malignancy 15%, other lymphoid malignancy 21%). Donors were unrelated in 64%. Conditioning was myeloablative in 94%. Peripheral blood grafts were used in 97%. At 3 years, overall survival was 61.0% (95% CI 55.3-67.3%), cumulative incidence of relapse was 32.6% (95% CI 26.2-38.5%) and transplant-related mortality was 18.8% (13.2-24.1%). 342 patients were evaluable for the primary endpoint of cGVHD requiring systemic immunosuppression (cGVHD-IS).  The cumulative incidence of cGVHD-IS at 3 years was 37.2% (95% CI 31.1-42.7%). On multivariate analysis, only prior grade 2-4 aGVHD (HR 3.08, 95% CI 2.10-4.52, P < .001) was associated with a significant increase in risk of cumulative incidence of cGVHD-IS. Recipient age of greater than 40 years was associated with significantly less cGVHD-IS (HR 0.66, 95% CI 0.45-0.97, P = .03) in univariate but not multivariate analysis. The use of unrelated donors, donor age over 40, female donor/male recipient gender combination and recipient CMV seropositivity were not associated with increased cGVHD-IS. There was insufficient power to determine the effect of graft type (peripheral blood vs bone marrow) on cGVHD-IS, but the incidence did not appear higher in peripheral blood graft recipients. In summary, in this cohort, traditional pre-transplant risk factors for cGVHD were not predictive. In patients undergoing in vivo T-cell depleted alloHSCT, novel predictors of cGVHD may be needed.
See more of: Poster Session 2: GVH/GVL
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