Risk factors associated with increased nonrelapse mortality and with poor overall survival in children with chronic graft-versus-host disease.

There is a paucity of information regarding the factors that affect nonrelapse mortality (NRM) and overall survival among children that develop chronic graftversus-host disease (cGVHD). We performed multivarlate analyses using data from the Center for International Rlood and Marrow Transplant Research to identify risk factors for NF1M and survival In 1117 pediatrIc subjects with leukemia or myelodysplastic syndrome, transplanted from related donors, unrelated donors (URD), or unrelated cord blood between 1995 and 2004. We identified 4 variables associated with higher NHM: HLA partially matched or mismatched URD, peripheral blood cell graft, Karnotsky/ Lansky score <80 at cGVHD diagnosis, and platelets < 100 x 109/L at cGVHD diagnosis. Factors associated with significantly worse survival were: age> 10 years, transplantation from HLA partially matched or mismatched URD, advanced disease at transplantation, Karnofskyl Lansky < 80; and platelets < 100 x 10~JL. Cumulative incidence of discontinuation of systemic immune suppression at 1, 3, and 5 years after diagnosis of cGVHD were 22% (20%..25%), 34°o (31%37%), and 37% (34%40%), respectively. This Is the largest study elucidating variables affecting outcome after diagnosis of cGVl-ID In pediatric allograft recipients. These variables may be useful for risk stratification, development of future clinical trials, and family counseling In children with cGVHD. [ABSTRACT FROM AUTHOR]