Hyperacute Graft-Versus-Host Disease More Severe

Disease can occur within 14 days and prior to neutrophil engraftment

FRIDAY, April 6 (HealthDay News) -- Hyperacute graft-versus-host disease can occur very early after hematopoietic stem cell transplantation, even before neutrophil engraftment, and is associated with more severe disease, according to study findings published in the April 1 issue of Blood.

Daniel R. Couriel, M.D., from the University of Texas M.D. Anderson Cancer Center in Houston, and colleagues evaluated the incidence, risk factors, clinical manifestations and outcomes of hyperacute graft-versus-host disease (GVHD) in 809 patients undergoing hematopoietic stem cell transplantation. Hyperacute GVHD was defined as that occurring within 14 days of transplantation.

The investigators found that 27 percent of 265 patients with GVHD had biopsy-proven hyperacute disease that was more severe and was two times more likely to have skin involvement. Risk factors for hyperacute GVHD were mismatched donors (including sex mismatch), myeloablative conditioning and multiple prior rounds of chemotherapy. Patients with hyperacute GVHD responded poorly to first-line therapy and had higher non-relapse mortality.

"Our data show that acute GVHD comprises a clinical spectrum of GVHD that can occur early after transplantation, even before neutrophil engraftment," the authors write. "The timing of acute GVHD within this clinical spectrum has a definite impact on the outcomes of patients. Patients at risk for hyperacute GVHD should be considered for GVHD prophylaxis within a clinical trial whenever possible."

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