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Retrospective analysis of the incidence and outcome of late acute and chronic graft-versus-host disease—an analysis from transplant centers across Europe

Lookup NU author(s): Professor Anne Dickinson

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This work is licensed under a Creative Commons Attribution 4.0 International License (CC BY 4.0).


Abstract

2024 Langer, Lelas, Rittenschober, Piekarska, Sadowska-Klasa, Sabol, Desnica, Greinix, Dickinson, Inngjerdingen, Lawitschka, Vrhovac, Pulanic, Güneş, Klein, Moritz Middeke, Grube, Edinger, Herr and Wolff.Introduction: Chronic graft-versus-host disease (cGvHD) is a serious late complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods: This multicenter analysis determined the cumulative incidence (CI) of cGvHD and late acute GvHD (laGvHD) and its impact on transplantation-related mortality (TRM), relapse (R), and overall survival (OS) in 317 patients [296 adults, 21 pediatrics (<12 years of age)] who underwent their first allo-HSCT in 2017. Results: The CI of laGvHD was 10.5% in adults and 4.8% in pediatrics, and the CI of cGvHD was 43.0% in all adult transplant patients and 50.2% in the adult at-risk cohort at the study end. The onset of cGvHD was de novo in 42.0% of patients, quiescent in 52.1%, and progressive in 5.9%. In adults, prophylactic use of antithymocyte globulin or posttransplant cyclophosphamide was associated with a significantly lower incidence of cGvHD (28.7%) vs. standard prophylaxis with calcineurin inhibitors (30.6%) and methotrexate/mycophenolate mofetil (58.4%) (all p < 0.01). TRM was significantly higher in patients with aGvHD (31.8%) vs. cGvHD (12.6%) and no GvHD (6.3%) (all p = 0.0001). OS in the adult at-risk cohort was significantly higher in patients with cGvHD (78.9%) vs. without (66.2%; p = 0.0022; HR 0.48) due to a significantly lower relapse rate (cGvHD: 14.5%; without cGvHD: 27.2%; p = 0.00016, HR 0.41). OS was also significantly higher in patients with mild (80.0%) and moderate (79.2%) cGvHD vs. without cGvHD (66.2%), excluding severe cGvHD (72.7%) (all p = 0.0214). Discussion: The negative impact of severe cGvHD on OS suggests a focus on prevention of severe forms is warranted to improve survival and quality of life.


Publication metadata

Author(s): Langer R, Lelas A, Rittenschober M, Piekarska A, Sadowska-Klasa A, Sabol I, Desnica L, Greinix H, Dickinson A, Inngjerdingen M, Lawitschka A, Vrhovac R, Pulanic D, Gunes S, Klein S, Moritz Middeke J, Grube M, Edinger M, Herr W, Wolff D

Publication type: Article

Publication status: Published

Journal: Frontiers in Transplantation

Year: 2024

Volume: 3

Online publication date: 18/03/2024

Acceptance date: 04/03/2024

Date deposited: 02/10/2024

ISSN (electronic): 2813-2440

Publisher: Frontiers Media SA

URL: https://doi.org/10.3389/frtra.2024.1332181

DOI: 10.3389/frtra.2024.1332181

Data Access Statement: The raw data supporting the conclusions of this article will be made available by the authors, without undue reservation


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Funding

Funder referenceFunder name
Novartis Pharma AG

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