Table 3

Risk factors associated with treatment failure

FactorNUnivariateMultivariate
Hazard ratio (95% CI)PHazard ratio (95% CI)P
Patient age at initial treatment      
 0-39 97 1.00 (reference)  1.00 (reference)  
 40-49 77 1.05 (0.71-1.55) .81 1.00 (reference)  
 50-59 125 1.07 (0.77-1.49) .70 1.00 (reference)  
 ≥60 101 1.43 (1.01-2.01) .04 1.48 (1.13-1.95) .004 
Female donor to male recipient 108 1.03 (0.79-1.35) .81  
High-risk disease at transplantation 264 1.00 (0.78-1.29) .99  
Conditioning regimen     
 High dose without TBI 137 1.00 (reference)   
 High dose with TBI 81 1.38 (0.97-1.95) .07  
 Reduced intensity 182 1.46 (1.10-1.94) .009  
Graft source     
 Bone marrow 46 1.00 (reference)   
 Mobilized blood cells 332 1.22 (0.79-1.87) .37  
 Cord blood 22 0.90 (0.44-1.85) .78  
Donor and HLA type     
 HLA-matched related 147 1.00 (reference)   
 HLA-matched unrelated 155 1.12 (0.85-1.47) .44  
 HLA-mismatched 98 0.97 (0.70-1.33) .84  
Time from transplantation to initial systemic treatment     
 <6 mo 166 1.00 (reference)  1.46 (1.05-2.03) .02 
 6 to <12 mo 157 0.99 (0.76-1.29) .92 1.46 (1.05-2.03)  
 12 to <24 mo 66 0.74 (0.52-1.07) .11 1.00 (reference)  
 ≥24 mo 11 0.31 (0.10-0.99) .05 1.00 (reference)  
Presence of involvement at initial treatment     
 Skin 302 1.13 (0.84-1.51) .43  
 Eyes 115 1.18 (0.91-1.54) .21  
 Mouth 363 1.02 (0.66-1.56) .94  
 Liver 175 0.80 (0.63-1.03) .08  
 Gastrointestinal tract     
  No involvement 241 1.00 (reference)   
  Upper only 78 1.19 (0.87-1.63) .27  
  Any lower 81 1.35 (1.00-1.83) .05  
 Lungs 14 1.34 (0.71-2.53) .36  
 Joint or fascia 54 0.75 (0.51-1.10) .14  
 Genital tract 29 0.80 (0.49-1.31) .38  
Score 3 in the gastrointestinal tract, liver, or lungs 54 1.43 (1.02-2.01) .04 1.43 (1.02-2.02) .04 
No. of sites involved at initial treatment     
 1 or 2 136 1.00 (reference)   
 3 149 0.80 (0.59-1.07) .13  
 ≥4 115 1.10 (0.82-1.49) .53  
NIH global score at initial treatment     
 Moderate 228 1.00 (reference)   
 Severe 172 1.09 (0.86-1.40) .47  
Subcategory of chronic GVHD     
 Classic 45 1.00 (reference)   
 Overlap 355 1.11 (0.74-1.67) .61  
Karnofsky score <80% 140 1.32 (1.03-1.70) .03 1.29 (1.01-1.67) .04 
Thrombocytopenia at initial treatment 105 1.16 (0.89-1.53) .28  
Hyperbilirubinemia at initial treatment 16 1.13 (0.62-2.06) .70  
Progressive onset 39 0.79 (0.52-1.21) .28  
Prior grades II-IV acute GVHD 296 1.10 (0.82-1.46) .53  
Prednisone dose before onset of initial treatment     
 None 299 1.00 (reference)   
 <0.5 mg/kg daily 61 1.28 (0.92-1.77) .14  
 ≥0.5 mg/kg daily 40 0.92 (0.61-1.38) .67  
Initial treatment of chronic GVHD     
 Prednisone ± calcineurin inhibitor 203 1.00 (reference)   
 Prednisone + others* 136 0.82 (0.62-1.07) .15  
 Treatment without prednisone 61 0.99 (0.69-1.40) .94  
Prednisone dose used for initial treatment     
 No prednisone 61 1.00 (reference)   
 <0.5 mg/kg/daily 38 1.05 (0.64-1.72) .85  
 ≥0.5 but <1.0 mg/kg/daily 105 0.87 (0.59-1.29) .49  
 ≥1.0 mg/kg/daily 196 0.95 (0.67-1.35) .78  
Number of agents used for initial treatment     
 1 84 1.18 (0.86-1.60) .31  
 2 216 1.00 (reference)   
 ≥3 100 0.88 (0.66-1.18) .40  
FactorNUnivariateMultivariate
Hazard ratio (95% CI)PHazard ratio (95% CI)P
Patient age at initial treatment      
 0-39 97 1.00 (reference)  1.00 (reference)  
 40-49 77 1.05 (0.71-1.55) .81 1.00 (reference)  
 50-59 125 1.07 (0.77-1.49) .70 1.00 (reference)  
 ≥60 101 1.43 (1.01-2.01) .04 1.48 (1.13-1.95) .004 
Female donor to male recipient 108 1.03 (0.79-1.35) .81  
High-risk disease at transplantation 264 1.00 (0.78-1.29) .99  
Conditioning regimen     
 High dose without TBI 137 1.00 (reference)   
 High dose with TBI 81 1.38 (0.97-1.95) .07  
 Reduced intensity 182 1.46 (1.10-1.94) .009  
Graft source     
 Bone marrow 46 1.00 (reference)   
 Mobilized blood cells 332 1.22 (0.79-1.87) .37  
 Cord blood 22 0.90 (0.44-1.85) .78  
Donor and HLA type     
 HLA-matched related 147 1.00 (reference)   
 HLA-matched unrelated 155 1.12 (0.85-1.47) .44  
 HLA-mismatched 98 0.97 (0.70-1.33) .84  
Time from transplantation to initial systemic treatment     
 <6 mo 166 1.00 (reference)  1.46 (1.05-2.03) .02 
 6 to <12 mo 157 0.99 (0.76-1.29) .92 1.46 (1.05-2.03)  
 12 to <24 mo 66 0.74 (0.52-1.07) .11 1.00 (reference)  
 ≥24 mo 11 0.31 (0.10-0.99) .05 1.00 (reference)  
Presence of involvement at initial treatment     
 Skin 302 1.13 (0.84-1.51) .43  
 Eyes 115 1.18 (0.91-1.54) .21  
 Mouth 363 1.02 (0.66-1.56) .94  
 Liver 175 0.80 (0.63-1.03) .08  
 Gastrointestinal tract     
  No involvement 241 1.00 (reference)   
  Upper only 78 1.19 (0.87-1.63) .27  
  Any lower 81 1.35 (1.00-1.83) .05  
 Lungs 14 1.34 (0.71-2.53) .36  
 Joint or fascia 54 0.75 (0.51-1.10) .14  
 Genital tract 29 0.80 (0.49-1.31) .38  
Score 3 in the gastrointestinal tract, liver, or lungs 54 1.43 (1.02-2.01) .04 1.43 (1.02-2.02) .04 
No. of sites involved at initial treatment     
 1 or 2 136 1.00 (reference)   
 3 149 0.80 (0.59-1.07) .13  
 ≥4 115 1.10 (0.82-1.49) .53  
NIH global score at initial treatment     
 Moderate 228 1.00 (reference)   
 Severe 172 1.09 (0.86-1.40) .47  
Subcategory of chronic GVHD     
 Classic 45 1.00 (reference)   
 Overlap 355 1.11 (0.74-1.67) .61  
Karnofsky score <80% 140 1.32 (1.03-1.70) .03 1.29 (1.01-1.67) .04 
Thrombocytopenia at initial treatment 105 1.16 (0.89-1.53) .28  
Hyperbilirubinemia at initial treatment 16 1.13 (0.62-2.06) .70  
Progressive onset 39 0.79 (0.52-1.21) .28  
Prior grades II-IV acute GVHD 296 1.10 (0.82-1.46) .53  
Prednisone dose before onset of initial treatment     
 None 299 1.00 (reference)   
 <0.5 mg/kg daily 61 1.28 (0.92-1.77) .14  
 ≥0.5 mg/kg daily 40 0.92 (0.61-1.38) .67  
Initial treatment of chronic GVHD     
 Prednisone ± calcineurin inhibitor 203 1.00 (reference)   
 Prednisone + others* 136 0.82 (0.62-1.07) .15  
 Treatment without prednisone 61 0.99 (0.69-1.40) .94  
Prednisone dose used for initial treatment     
 No prednisone 61 1.00 (reference)   
 <0.5 mg/kg/daily 38 1.05 (0.64-1.72) .85  
 ≥0.5 but <1.0 mg/kg/daily 105 0.87 (0.59-1.29) .49  
 ≥1.0 mg/kg/daily 196 0.95 (0.67-1.35) .78  
Number of agents used for initial treatment     
 1 84 1.18 (0.86-1.60) .31  
 2 216 1.00 (reference)   
 ≥3 100 0.88 (0.66-1.18) .40  

Treatment failure was defined by the onset of second-line systemic treatment, nonrelapse death, or recurrent malignancy during first-line treatment. TBI, total body irradiation.

*

Other treatments include extracorporeal photopheresis, rituximab, thalidomide, alemtuzumab, infliximab, antithymocyte globulin, and methotrexate. Risk of treatment failure did not differ statistically according to any individual agent.

View Large
This Feature Is Available To Subscribers Only

or Create an Account

Close Modal
Close Modal