1. Higher CD3+ and CD34+ cell doses in the graft increase the incidence of acute GVHD in children receiving BMT for thalassemia.
- Author
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Gaziev, J, Isgrò, A, Marziali, M, Daniele, N, Gallucci, C, Sodani, P, Simone, M D, Adorno, G, Paciaroni, K, Andreani, M, Lanti, A, Del Proposto, G, Testi, M, De Angelis, G, Roveda, A, Alfieri, C, Saltarelli, F, and Lucarelli, G
- Subjects
GRAFT versus host disease ,DISEASE incidence ,DISEASE risk factors ,JUVENILE diseases ,BONE marrow transplantation ,THALASSEMIA treatment - Abstract
We evaluated the incidence of GVHD, risk factors and the impact of graft composition on acute GVHD (aGVHD) in 92 children who underwent BMT for thalassemia following busulfan/cyclophosphamide (BUCY)-based conditioning regimens and GVHD prophylaxis with CSA/short-MTX and methylprednisolone. The incidence of grade 2-4 and 3-4 aGVHD was 35% (95% confidence interval (CI) 25-44) and 9% (95% CI 4-16), respectively. We found that CD3
+ and CD34+ cell doses above the median were associated with high incidence of grade 2-4 aGVHD (49 vs 20%, P=0.005 and 46 vs 23%, P=0.021, respectively). In multivariate analysis, high CD3+ (hazard ratio (HR) 4.6; 95% CI 1.4-14.7; P=0.010) and CD34+ (HR 4.3; 95% CI 1.4-12.7; P=0.011) cell doses were associated with grade 2-4 aGVHD. We further examined the effect of CD3+ and CD34+ cell doses on aGVHD using quartile cutoff points and found a minimum threshold for CD3+ (38 × 106 /kg) and CD34+ (4 × 106 /kg) cells above which the incidence of grade 2-4 aGVHD is significantly increased. This study shows for the first time a positive correlation between the number of CD3+ and CD34+ cells and aGVHD in children receiving sibling BMT, and indicates that using tailored and more intensive post transplant immunosuppression may permit to better control aGVHD. [ABSTRACT FROM AUTHOR]- Published
- 2012
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