DEATH BY GRAFT-VERSUS-HOST DISEASE ASSOCIATED WITH HLA MISMATCH, HIGH RECIPIENT AGE, LOW MARROW CELL DOSE, AND SPLENECTOMY

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Abstract
In 65 recipients of marrow from HLA-identical siblings, the death rate from graft-vs.-host disease (GVHD) at 1 yr was 13%, which was significantly less when compared with 50% among 10 recipients of marrow from HLA-non-identical donors (P < 0.001 log-rank test). Among recipients of HLA-matched marrow the following was found: patients < 17 yr of age had a death rate from GVHD of 4% compared with 32% in elder patients (P < 0.01). In patients who received .gtoreq. 3 .times. 108 marrow cells/kg 3% died of GVHD compared with 31% in those receiving fewer marrow cells (P < 0.02). Furthermore, death by GVHD was 11% among nonsplenectomized patients compared with 60% in splenectomized patients (P < 0.001). Among all children, and among nonsplenectomized patients, those receiving < 3 .times. 108 marrow cells/kg had a significantly increased death rate by GVHD. The number of T cells or T cell subsets in the marrow graft was not correlated with GVHD or death by GVHD.