Epidemiology of Chronic Graft-Versus-Host Disease in the Pediatric Recipients of Hematopoietic Stem Cell Transplantation

Most studies into the epidemiology of chronic graft-versus-host- disease (cGVHD) have focused on adult hematopoietic stem cell transplant (HSCT) recipients.  To determine whether the clinical factors that contribute to the development of cGVHD in pediatric HSCT recipients differed from those implicated in adult HSCT recipients, we undertook a cross-sectional, single institution study of pediatric HSCT recipients who were more than one year following their myeloablative HSCT.  Pediatric recipients were transplanted between 1998 and 2011.  Thirty-one (31) recipients with either active (14) or resolved (17) cGVHD were identified and compared to 47 pediatric HSCT recipients without cGVHD [40 recipients with no history of acute GVHD (Grade II-IV) and 7 recipients with a history of only acute GVHD].   All clinical records were re-evaluated by a single observer and graded for the severity of both acute and cGVHD using the NIH Consensus Scoring Criteria.  Recipients’ clinical characteristics were determined.  Among the variables that did not differ significantly between HSCT recipients with and without cGVHD were: recipient age, donor age (of bone marrow donors), use of TBI containing preparative regimes, malignant versus non-malignant diseases, and female donor/male recipient.  The use of bone marrow as the HSC source, matched related donors, and the absence of acute GVHD were all associated with a decreased probability of cGVHD.  No significant differences were identified between the patients who had active cGVHD and those who had resolved cGVHD.