A retrospective analysis identified a pattern of poor clinical outcomes for patients who experienced acute graft-versus-host disease (GVHD) after allogeneic hematopoietic cell transplantation (HCT). The researchers recently reported their findings in the journal Bone Marrow Transplantation.
“In this multicenter, retrospective chart review, 40% of patients with acute GVHD experienced disease progression and developed severe disease (grades [3-4]) despite the use of systemic treatment,” the researchers reported.
The study was conducted at 11 transplant centers in the US and evaluated outcomes for patients aged 12 years and older who developed acute GVHD grades 2 to 4 after a first HCT. The researchers followed treatment patterns and outcomes for patients in whom HCT occurred between January 2014 and June 2016. This was prior to the US Food and Drug Administration approval of ruxolitinib for steroid-refractory acute GVHD, and the use of Janus kinase (JAK) inhibitor therapy was among exclusion criteria for this study.
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The analysis included 475 patients, median age 55 years (IQR, 44 to 63) at baseline. After the date of the acute GVHD diagnosis, 40.0% of patients experienced progression to a more severe grade of acute GVHD and/or new organ involvement.
Acute GVHD was initially diagnosed at grades 2 to 4 for 431 patients. First-line systemic corticosteroids were used in treatment of 73.1% of these patients. By a median follow-up of 524 days after acute GVHD diagnosis, steroid dose increases were reported for 23.4% of patients, and steroid treatment could not be tapered to less than 10 mg/day for 44.4%.
Chronic GVHD developed in 40.2% of total patients. Hospital readmissions within 100 days after HCT occurred with 54.9% of all patients, and 2 or more readmissions in this time period occurred with 22.3% of patients. Readmissions were associated with a median length of stay of 27.5 days.
More than half (52.8%) the patients died. The 12-month overall mortality rate after acute GVHD diagnosis was 35.2%, while the nonrelapse mortality rate was 25.5%. Mortality rates during the follow-up period were worse with higher-grade acute GVHD at diagnosis and with progression to a more severe grade after diagnosis.
“In conclusion, these findings suggest that there is a need for effective and tolerable treatments administered early in the disease course of acute GVHD to prevent or reverse disease progression,” the researchers concluded in their report.
Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.
Reference
Holtan SG, Yu J, Choe HK, et al. Disease progression, treatments, hospitalization, and clinical outcomes in acute GVHD: a multicenter chart review. Bone Marrow Transplant. Published online July 30, 2022. doi:10.1038/s41409-022-01764-w
