Previous Infections in the Allogenic Hematopoietic Stem Cell Transplant Receiver, As a Risk Factor for the Development of Acute Graft Versus Host Disease

Introduction: Acute graft versus host disease (aGVHD) is the most common and serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Incidence goes from 30 to 80%; such wide ranges are determined by various clinical risk factors. Previous infections before the allo-HSCT may stimulate an immune response and become an independent risk factor for inducing aGVHD

Objectives: Determine whether previous infections in the recipient of an allo-HSCT is a risk factor for the development of aGVHD in the service of Hematopoietic  Stem Cell  Transplantation,  National Institute of Pediatrics in the period January 1998 to December 2011

Material and methods: Univariate analysis performed to determine the frequency of aGVHD for each risk factor, determining bivariate associations between variables in estimating relative risk in the associations studied. Chi square and exact Fisher’s tests were used to determine statistical significance. The significant variables in the bivariate analysis, entered into multivariate analysis (logistic regression) to determine the contribution of each of the factors for the presence of disease. Value p≤ 0.05 was statistically significant.

Outcomes: 115 patients underwent allo-HSCT. The different indications for HSCT were: Malignant hematological diseases 69 cases (60%), Primary immunodeficiencies 27 cases (23.4%), Benign hematologic diseases 12 cases (10.4%), Inherited metabolic diseases 6 cases (5.2%), and Miscellaneous 1 case (0.86%).

Twenty seven patients developed aGVHD: factors that increased the risk for the development of aGVHD were: Infections three months prior to transplantation (OR 4.5 p <0.03), Prior infection with cytomegalovirus in the recipient (OR 4.6  p <0.03), Peripheral blood supply (OR 11.4  p <000.1), Peripheral blood greater than bone marrow (OR 16.3  p <0.001), and Cell dose > 8.3 x10⁶/kg (OR 4.6  p <0.03)

Conclusions: We found that the overall incidence of aGVHD without taking into consideration the clinical grade was 23.4%. Excel infectious processes three months prior to allo-HSCT process and prior cytomegalovirus infection as relevant risk factors.