Risk factors for acute graft-versus-host disease in patients undergoing transplantation with CD34+ selected blood cells from HLA-identical siblings.

A study on 315 patients undergoing transplantation with CD34+ selected blood cells from HLA-identical siblings was performed to determine risk factors for acute GVHD (aGVHD). Recipients of a dose of CD34+ cells (× 106/kg) of 2 or less, more than 2 to 4, and more than 4 had a cumulative incidence of aGVHD grades I-IV of 21%, 35%, and 43%, respectively (log-rank P  = .01); similarly, recipients of a dose of CD3+ cells (× 106/kg) of 0.05 or less, more than 0.05 to 0.1, and more than 0.1 had a cumulative incidence of aGVHD grades I-IV of 18%, 35%, and 44%, respectively (log-rank P  = .007). Using a Cox regression model, 4 independent factors for aGVHD I-IV were identified: increased CD34+cell dose ( P  = .02), increased CD3+ cell dose ( P  = .02), female patients ( P  = .01), and higher patient age (> 42 years) ( P  = .007). This study shows, for the first time in T-cell–depleted transplantations, a positive correlation between the number of CD34+ cells and aGVHD and, also, that the number of CD3+ cells necessary to initiate aGVHD is lower than previously reported.