Risk Factors Of Graft-Versus-Host Disease In Patients With Thalassemia Major After Transplantation

Objective To analysis risk factors of graft-versus-host disease after allogeneic hematopoietic stem cell transplantation from siblings donor in 237 patients with thalassemia major.Method We retrospectively analyzed the clinical data of 237 patients with thalassemia major who were treated with heterotopic allogeneic hematopoietic stem cell transplantation(Allo-HSCT)in our hospital.We analysis the effect of patient and donor situation(include recipient sex,recipient age,liver size,serum ferritin level,ATG,donor sex,,donor age,female/ male donor-to-recipient combination,HLA match,ABO match,graft type,total number of MNCs)on the graft-versus-host disease in 237 patients with severe ?-thalassemia by using univariate and multivariate analysis.Result 30 patients suffer from graft-versus-host disease.27 patients suffer from acute graft-versus-host disease.Among them,18 patients suffer from ?-? aGVHD.In addition,9 patients suffer from chronic graft-versus-host disease.Univariate analysis showed that recipient age,donor age,HLA match and graft source were risk factors affecting ?-? aGVHD.Multivariate analysis showed that donor age,HLA match and graft source were independent risk factors for ?-? aGVHD.The cumulative incidence of ?-? aGVHD(40.0%)in HLA mismatch group was significantly higher than that in HLA-matched group(6.9%)(P = 0.003).The cumulative incidence of ?-? aGVHD(14.9%)in peripheral blood combined with bone marrow was significantly higher than that in umbilical cord blood combined with bone marrow group(0.8%)(P <0.001).The cumulative incidence of ?-? aGVHD(25.0%)in donor age over 10 y was significantly higher than that in donor age below 10y(4.0%)(P <0.001).Univariate analysis showed that donor age,patient liver size before transplantation and ATG dose were risk factors for cGVHD.Multivariate analysis showed that the donor age and dose of ATG were independent risk factors for cGVHD.The incidence of cGVHD(13.9%)in the donor age ? 10 years was significantly higher than that in the donor age <10 years group(2.0%)(P <0.001).The cumulative incidence of cGVHD in the ATG 10 mg group(2.0%)was significantly lower than that in the ATG 8 mg(14.7%)(P <0.001).Conclusion HLA match,graft source and donor age is an independent risk factor affecting the incidence of ?-? aGVHD.Doses of ATG,donor age were independent risk factors for cGVHD.