Dr. Chen on Risk Factors for Developing cGVHD

Yi-Bin Chen, MD, director, BMT Program, Cara J. Rogers Endowed Scholar, Massachusetts General Hospital, associate professor of medicine, Harvard Medical School, discusses risk factors for developing chronic graft-vs-host disease (cGVHD) in patients who receive an allogeneic transplant.

Certain factors, such as older age, male patients who receive a graft from a female donor, and the transplant platform, increase a patient’s risk of developing cGVHD, Chen explains. Utilizing myeloablative conditioning therapy, particularly with high-dose total body irradiation, instead of reduced-intensity or nonmyeloablative therapy also increases the risk of a patient developing cGVHD.

Additionally, the type of donor and the graft source influences a patient’s risk of developing cGVHD, Chen says. Data from randomized studies have shown that grafts with peripheral blood stem cells are associated with a higher incidence of cGVHD vs bone marrow or cord blood. However, with the latter options, early complications can arise that require management, Chen adds. Notably, the development of acute GVHD is the biggest risk factor for developing cGVHD.

Ultimately, prevention of cGVHD is critical. Including polyclonal anti–T-cell globulins, such as ATG products, and ex vivo manipulations, such as T-cell depletion, reduces the incidence of cGVHD, Chen says. A post-transplant, high-dose, cyclophosphamide-based GVHD prevention strategy is an additional, novel approach to mitigate cGVHD risk.