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Predictive Factors in Chronic Graft-Versus-Host Disease in Patients with Aplastic Anemia Treated by Marrow Transplantation from HLA-Identical Siblings

RAINER STORB, M.D.; ROSS L. PRENTICE, Ph.D.; KEITH M. SULLIVAN, M.D.; HOWARD M. SHULMAN, M.D.; H. JOACHIM DEEG, M.D.; KRISTINE C. DONEY, M.D.; C. DEAN BUCKNER, M.D.; REGINALD A. CLIFT, F.I.M.L.S.; ROBERT P. WITHERSPOON, M.D.; FREDERICK A. APPELBAUM, M.D.; JEAN E. SANDERS, M.D.; PATRICIA S. STEWART, M.D.; and E. DONNALL THOMAS, M.D.
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Grant support: in part by grant CA 18029, CA 15704, CA 30924, and CA 18221 from the National Cancer Institute. Drs. Sullivan and Stewart are supported in part by Junior Faculty Clinical Fellowships from the American Cancer Society. Dr. Thomas is the recipient of Research Career Award AI 02425 from the National Institute of Allergy and Infectious Diseases.

▸Requests for reprints should be addressed to Rainer Storb, M.D.; Division of Oncology, Fred Hutchinson Cancer Research Center, 1124 Columbia Street; Seattle, WA 98104.


Seattle, Washington


© 1983 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1983;98(4):461-466. doi:10.7326/0003-4819-98-4-461
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One hundred ten of 175 patients with aplastic anemia conditioned by cyclophosphamide had sustained engraftment of marrow from human leukocyte antigen (HLA)-identical siblings and lived for more than 6 months. Forty-nine of the 110 patients developed chronic graft-versus-host disease between 85 and 464 days. Ninety-seven patients are alive from 1.4 to 11 years after engraftment; 13 died between 208 and 726 days. Twenty of the 36 surviving patients with chronic graft-versus-host disease have Karnofsky performance scores of 100%, 7 of 90%, 5 of 80%, 1 of 70%, 2 of 60%, and 1 of 40%. Our analysis, using a binary logistic regression model, identified three factors predicting chronic graft-versus-host disease: moderate to severe acute graft-versus-host disease with an estimated relative risk of 11.65; increasing patient age; and the use of viable donor buffy coat cells in addition to the marrow to prevent graft rejection. The last two factors were significant only in patients without acute graft-versus-host disease.

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