Risk and prognostic factors for Japanese patients with chronic graft-versus-host disease after bone marrow transplantation
The incidence and prognostic factors for chronic graft-versus-host disease (cGVHD) were evaluated for 255 Japanese patients who survived more than 100 days after bone marrow transplantation, and of whom 119 (47%) developed cGVHD. Prior acute GVHD (grade 2–4) and use of an unrelated donor were significantly associated with the onset of cGVHD. Presence of cGVHD did not have an impact on mortality (hazard ratio (HR)=0.89; 95% confidence interval (CI), 0.59–1.3). Three factors at diagnosis were associated with cGVHD-specific survival: presence of infection (HR=4.1; 95% CI, 1.6–10.3), continuing use of corticosteroids at the onset of cGVHD (HR=3.9; 95% CI, 1.7–9.1), and a Karnofsky performance score <80 (HR=4.7; 95% CI, 2.0–11.3). The probability of cGVHD-specific survival at 4 years was 79% (95% CI, 70–86%). The severity and death rate of Japanese patients with cGVHD was lower than those for populations in Western countries, which might be the result of greater genetic homogeneity of Japanese ethnics. Our patients could not be accurately classified when the proposed prognostic models from Western countries were used, thus indicating the need for a different model to identify high-risk patients.