Abstract Background: Graft-versus-host disease (GVHD) is a common and
undesirable complication of hematopoietic cell transplant (HCT) for
non-malignant disorders (NMD). Understanding the incidence and risk
factors for GVHD in children with NMD is an important step in developing
strategies for its prevention. Study Design: This is a retrospective,
registry, study that included children with NMD receiving HCT in 5
centers in Florida between 2010 and 2019. Results: Among 183 patients
evaluable for GVHD, acute GVHD (aGVHD) grades I, II, III, and IV were
present in 18%, 12.6%, 3.8% and 5.5% of patients, respectively.
Limited and extensive chronic GVHD (cGVHD), were observed in 8.7% and
12.6% of patients. Patients with aGVHD grade III/IV had significantly
lower 3-year survival rates than those without aGVHD, or those with
aGVHD grade I/II (52.9% [95% confidence interval (CI) 34-83] vs.
90.1% [95% CI 84-96], vs. 98.1% [95%CI 95-100],
p<0.001). Patients without cGVHD and those with limited and
extensive cGVHD had 3-year survival rates of 88.9% [95%CI 84-94],
91.7% [95%CI 77-100], and 84.8% [95%CI 70-100],
respectively, log rank p=0.3. Receiving transplant from an
HLA-mismatched unrelated donor (MMUD), as compared to a matched related
donor (MRD), increased the risk for aGVHD grade III/IV (Odds ratio 10.4
[95% CI 2.5-47.6]). There were no cases of aGVHD grade III/IV among
recipients of mismatched related/haploidentical transplants.
Conclusions: Grade III/IV aGVHD, which significantly reduced overall
survival, was reported in 9.3% of children with NMD receiving HCT. Risk
factors included HCT from a MMUD but not mismatched related donors.
Minimal Change Disease (MCD) Secondary to Chronic Graft Versus Host Disease (GVHD) in Two Adult Patients after Allogeneic (Allo) Hematopoietic Cell Transplant (HCT) for Myelodysplastic Syndrome (MDS)
