Patients who developed severe acute graft-versus-host disease (aGVHD) showed a 5-year survival rate of 77.5%. These study results were published in the journal Transplantation and Cellular Therapy.
Development of grade 3 or 4 aGVHD after allogeneic hematopoietic cell transplantation (HCT) has been associated with a poor prognosis in terms of 1-year survival, the study investigators explained in their report. They had a study aim of examining outcomes faced by patients with grade 3 or 4 aGVHD who have survived at least 1 year following HCT.
In this study, the researchers performed a retrospective chart review and evaluated annual surveys of patient-reported outcomes. Patients included in the analysis were adults who had survived for at least 1 year after HCT, with patients’ first and only HCT having occurred between 2001 and 2019. The researchers evaluated outcomes for patients who had developed aGVHD grade 0 or 1, compared with those who had developed aGVHD grade 3 or 4.
There were 615 patients who had grade 0 or 1 aGVHD and 192 patients who had grade 3 or 4 aGVHD. The study had a median follow-up time for survivors of 7.2 years.
Patients who had aGVHD grade 3 or 4 showed significantly higher cumulative incidences of late medical comorbidities (P <.001) than did patients who had grade 0 or 1 aGVHD, including minor, intermediate, and major late effects. Late medical comorbidities also occurred at higher cumulative incidences across various organ systems in patients who had developed grade 3 or 4 aGVHD.
The 5-year overall survival (OS) rate for patients who developed grade 3 or 4 aGVHD was 77.5%, compared with 83.6% in patients who developed grade 0 or 1 aGVHD (P =.006). A multivariable analysis showed a worse OS among patients who developed more severe aGVHD with a hazard ratio of 1.87 (95% CI, 1.35-2.60; P <.001).
Nonrelapse mortality at 5 years was also higher for those who had grade 3 or 4 aGVHD (19.2%), compared with grade 0 or 1 aGVHD (10.6%). A multivariable analysis showed that patients in the group with more severe aGVHD had higher nonrelapse mortality with a hazard ratio of 2.61 (95% CI, 1.81-3.76; P <.001).
Patients who developed aGVHD grade 3 or 4, compared with grade 0 or 1, also showed significantly worse physical (P =.01) and mental (P =.04) functioning, although these results regarding functioning did not meet a threshold for being clinically meaningful. Chronic GVHD occurred at similar rates between groups.
The study investigators concluded that this study showed significantly worse outcomes after recovering from grade 3 or 4 aGVHD, compared with recovery from grade 0 or 1 aGVHD. “These data can provide patients with a more in depth understanding of post-transplant complications and the recovery process after severe aGVHD to allow them to better participate in their health care,” the investigators concluded.
Rashid N, Krakow EF, Yeh A, et al. Late effects of severe acute GVHD on quality of life, medical comorbidities and survival. Transplant Cell Ther. Accepted manuscript. Published online August 31, 2022. doi:10.1016/j.jtct.2022.08.027