Risk Factors for Acute and Chronic GVHD

Transcript:
Bonnie J. Dirr, APRN: Dr Gooptu, for patients coming forth to transplant, what factors are associated that increase the risk of developing graft-vs-host disease [GVHD]? And is there any difference for the risk of acute vs chronic graft-vs-host disease? For CB, what were the statistics that you provided for him in terms of his acute and chronic graft-vs-host disease statistics at the time of his transplant?

Mahasweta Gooptu, MD: That’s a great question. There are a few factors which can modify your risk of graft-vs-host disease. Some of them are common to acute and chronic forms of graft-vs-host disease, while some seem to affect a particular form more than others. So, donor type used to be one of the most important factors affecting the risk of acute and chronic GVHD, and still remains very important even in the posttransplant cyclophosphamide era. As I mentioned, matched related donors typically are associated with the lowest risk of graft-vs-host disease, followed by matched unrelated donors and [followed by] mismatched donors. The kind of conditioning regimen used can sometimes affect the risk of GVHD; particularly, the use of [total body irradiation] or melphalan have been associated with higher risk of GVHD. The donor age is particularly important. Younger donors are associated with lower rates of graft-vs-host disease. The gender mismatch between donor and recipient can also affect GVHD sometimes, and I would say one of the most important factors affecting chronic GVHD rates is the product that we use. So, if you use bone marrow product, that is associated with lower rates of chronic GVHD, which has been shown in multiple studies and a large, randomized study published in the New England Journal [of Medicine] as well. Unfortunately, as in CB’s case, we don’t always get marrow product, but it really depends on what the donor is willing to do. Those are some of the more important factors that affect the risk of GVHD.

Transcript edited for clarity.