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2013 ; 121
(25
): 5098-103
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Incidence, risk factors, and outcomes of sclerosis in patients with chronic
graft-versus-host disease
#MMPMID23547053
Inamoto Y
; Storer BE
; Petersdorf EW
; Nelson JL
; Lee SJ
; Carpenter PA
; Sandmaier BM
; Hansen JA
; Martin PJ
; Flowers ME
Blood
2013[Jun]; 121
(25
): 5098-103
PMID23547053
show ga
Sclerotic chronic graft-versus-host disease (GVHD) can result in disability after
allogeneic hematopoietic cell transplantation. We assessed the incidence and risk
factors of sclerosis and its association with transplant outcomes among 977
consecutive patients treated with systemic immunosuppression for chronic GVHD.
Sclerosis was defined when cutaneous sclerosis, fasciitis, or joint contracture
was first documented in the medical record. Seventy (7%) patients presented with
sclerosis at the time of initial systemic treatment for chronic GVHD, and the
cumulative incidence of sclerosis increased to 20% at 3 years. Factors associated
with an increased risk of sclerosis included the use of a mobilized blood cell
graft and a conditioning regimen with > 450 cGy total body irradiation. Factors
associated with a decreased risk of sclerosis included the use of an
HLA-mismatched donor and a major ABO-mismatched donor. Development of sclerosis
was associated with longer time to withdrawal of immunosuppressive treatment but
not with risks of overall mortality, nonrelapse mortality, or recurrent
malignancy. We found a substantial incidence of sclerosis in patients with
chronic GVHD. Development of sclerosis can cause disability but does not affect
mortality or recurrent malignancy in patients with chronic GVHD.