Risk factors associated with chronic cutaneous graft-versus-host disease following hematopoietic stem cell transplantation: a pediatric cohort

BACKGROUND: Graft-versus-host disease (GVHD) is a frequent complication of hematopoietic stem cell transplantation (HSCT), with the skin being the most commonly affected organ. However, its risk factors remain poorly defined.

OBJECTIVE: To assess the risk factors associated with chronic cutaneous GVHD (ccGVHD) in a children's hospital in Chile.

METHODS: This retrospective cohort study examined children under 18-years who underwent HSCT between 2007 and 2017, with a follow-up period of at least 2-years. Survival analysis and Cox regression analysis were performed.

RESULTS: 150 children with HSCT were included with a median age of 7.3 (3.7‒10.6) years. 17.3% of the children developed ccGVHD, with a median onset after HSCT of 8 (4‒11) months. In the univariate analysis, patients with ccGVHD were significantly older at transplantation, with a higher proportion of bone marrow as graft source, related donor, and acute GVHD compared to those who did not develop ccGVHD (for all p < 0.05). In the multivariate analysis, the main risk factors were male sex (Hazard Ratio [HR] 2.51), total body irradiation as conditioning regimen (HR = 3.53), and bone marrow as graft source (HR = 7.28).

STUDY LIMITATIONS: Its retrospective, single-center design may reduce generalizability and introduce selection bias.

CONCLUSIONS: This study is one of the largest series of ccGVHD in children. Early identification of patients at higher risk of ccGVHD allows for timely initiation of treatment, thereby reducing the morbidity associated with this debilitating complication.