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Advances in Hematology
Volume 2011 (2011), Article ID 601953, 8 pages
Clinical Study

Steroid-Refractory Acute GVHD: Predictors and Outcomes

1Stem Cell Transplantation & Cellular Therapy, M.D. Anderson Cancer Center, Houston, TX 77030, USA
2Blood and Marrow Transplant Program, University of Michigan Comprehensive Cancer Center, Ann Arbor, MI 48109, USA

Received 19 August 2011; Accepted 30 September 2011

Academic Editor: Myriam Labopin

Copyright © 2011 Jason R. Westin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Patients with steroid-resistant acute graft versus host disease (aGVHD) have a dismal prognosis, with mortality rates in excess of 90%. We sought to identify a subgroup of patients less likely to benefit from initial therapy with corticosteroids as well as the impact of response on day 14 on outcome. Retrospective evaluation was performed of patients with biopsy-proven aGVHD treated with corticosteroids after allogeneic HSCT at M.D. Anderson Cancer Center from 1998 through 2002 ( 𝑁 = 2 8 7 ). Overall response to first-line therapy on day 14 was 56%. Grade III-IV aGVHD and hyperacute GVHD were the most significant factors predicting failure. Patients who fail to respond to steroids by day 14 should be considered for clinical trials. Severity of aGVHD, hyperacute GVHD, and sex mismatch could be integrated into prognostic scoring systems which may allow for pretreatment identification of patients unlikely to benefit from standard therapy with corticosteroids.