Chronic Graft Versus Host Disease After Allogeneic Bone Marrow Transplantation; An Analysis of Incidence and Risk Factors.

background: chronic graft versus host disease (cgvhd) is one of the most serious potential complications of allogeneic bone marrow transplantation.
study design and method: we analyzed the incidence of cgvhd and its associated risk factors in a group of 161 iranian recipients of hla-identical sibling transplants, with at least 90 days post-transplantation survival. in the majority of cases (n=73), cgvhd occurred in the first year after the transplant (median 273 days). the actual probability of cgvhd within 1 year was 45.3±7% (ci 95%).
results: in a univariate analysis, the most important risk factor was the type of transplant. peripheral blood stem cell transplants (pbsct) showed a significant increase in cgvhd compared with bone marrow transplants (bmt) (rr=2.34, p<0.001). in addition, male recipients were at a greater risk than female recipients (rr=2.08, p=0.004). other risk factors were the presence of prior acute gvhd (rr=2.37, p=0.04) and the previous acute gvhd grade (p=0.03); the probabilities of cgv d in patients with grade 0, ι, ιі, ιιι, ιv acute gvhd were 24%, 44.7%, 42.6%, 56.8%, 64.3%, respectively.
conclusion: in a multivariate analysis, the only independent predictive factors for the development of cgvhd were the type of transplant (pbsc>bm, p<0.001) and male recipient (p=0.005). the survival rate was 88.8% and there was no significant difference in the probability of survival between bpsct vs bmt (93.8% vs 86.6%, p=0.5).