Risk factors for acute graft-versus-host disease after allogeneic blood stem cell transplantation

We evaluated demographic characteristics and graft composition as risk factors for acute graft-versus-host disease (GVHD) in 160 adult recipients of HLA-identical allogeneic blood stem cell transplants. The patients received a median nucleated cell dose of 7.9 x 10⁸/kg and median C34⁺ cell dose of 5.6 x 10⁶/kg. GVHD prophylaxis consisted of cyclosporine (CSA) and steroids, tacrolimus (FK506) and steroids, or FK506 and methotrexate. Grades 2 to 4 GVHD occurred in 31% (95% CI, 23% to 39%), and grades 3 to 4 GVHD in 14% (95% CI, 8% to 20%). In univariate analyses, GVHD prophylaxis with CSA and high CD34⁺ cell doses were significant risk factors for grades 2 to 4 GVHD, but diagnosis, age, use of total body irradiation, donor sex, female donor for male recipient, donor parity, donor alloimmunization, viral serology, nucleated cell dose, CD3⁺ cell dose, and CD56⁺ cell dose did not alter the incidence of GVHD significantly. With a CD34⁺ cell dose less than 8 x 10⁶ CD34⁺ cells/kg, the risk of grades 2 to 4 GVHD was significantly higher for those who received CSA (39%, 95% CI, 21% to 47%) in comparison with those on FK506 (18%, 95% CI, 10% to 26%) (P = .03), but GVHD prophylaxis regimen had less impact with a higher CD34⁺ cell dose (overall grades 2 to 4 GVHD rate 52%, 95% CI, 37% to 67%). GVHD prophylaxis and CD34⁺ cell dose are independent risk factors for acute GVHD after allogeneic blood stem cell transplantation.