Chronic graft versus host disease (cGVHD) is the most frequent long-term complication after allogeneic stem cell transplantation (allo-SCT) and results in impaired quality of life and increased long-term morbidity and mortality. We analyzed 243 patients with cGVHD, documented according to the 2005 revised National Institutes of Health consensus criteria, to identify risk factors for the occurrence of cGVHD and outcomes for the patients with cGVHD. Patients without evidence of cGVHD (n = 147) were used as controls. Performing univariate and multivariate Cox regression analyses, we identified prior acute GVHD grades III or IV (hazard ratio [HR], 2.01; P = .005), use of peripheral blood stem cell graft (HR, 2.10; P = .03), and HLA-mismatched allo-SCT from unrelated donor (HR, 1.57; P = .02) as independent risk factors for cGVHD. Performing Kaplan-Meier analyses, progressive compared with de novo and quiescent onset of cGVHD and a platelet count of less than 100/nL compared with more than 100/nL at the time of cGVHD onset were associated with a significantly increased cumulative incidence of transplantation-related mortality (TRM) and significantly decreased overall survival. Furthermore, we found a significantly higher incidence of TRM in patients with severe cGVHD compared with patients without cGVHD (58% versus 11%, P < .0001). However, in subgroup analysis, patients with severe cGVHD and involvement of the lung, liver, or gastrointestinal (GI) tract had a 6.5-fold significantly higher incidence of TRM (72%), whereas patients with severe cGVHD lacking lung, liver, or GI involvement had only a 2.8-fold significantly higher incidence of TRM (31%) compared with patients without cGVHD (11%; P < .0001 and P = .03). Patients without lung, liver, or GI involvement did not have a significantly different TRM compared with patients with moderate cGVHD (31% versus 25%, P = .52). In conclusion, we confirm prior known risk factors for the occurrence of cGVHD and subsequent mortality and we provide evidence that the presence of lung, liver, or GI involvement in patients with severe cGVHD defines a subgroup with high mortality after allo-SCT; however, in the absence of these risk factors, the outcome appears not to be impaired compared with moderate cGVHD.
ABSTRACT
PUBLICATION RECORD
- Publication year
2016
- Venue
Biology of Blood and Marrow Transplantation
- Publication date
2016-10-01
- Fields of study
Medicine
- Identifiers
- External record
- Source metadata
Semantic Scholar, PubMed
CITATION MAP
EXTRACTION MAP
CLAIMS
CONCEPTS
- acute gvhd grades iii or iv
Severe prior acute graft-versus-host disease used as a clinical risk factor in the regression analyses.
Aliases: prior acute GVHD grades III or IV, acute GVHD III-IV
- chronic graft-versus-host disease
A long-term complication after allogeneic stem cell transplantation that was the main condition analyzed in this cohort.
Aliases: cGVHD
- de novo onset
A cGVHD onset pattern that appears without a preceding acute graft-versus-host disease phase.
Aliases: de novo onset of cGVHD
- hla-mismatched allo-sct from unrelated donor
Allogeneic stem cell transplantation from an unrelated donor with human leukocyte antigen mismatch.
Aliases: HLA-mismatched allogeneic stem cell transplantation from unrelated donor, HLA-mismatched unrelated-donor allo-SCT
- lung, liver, or gastrointestinal involvement
Involvement of the lung, liver, or gastrointestinal tract by cGVHD at onset or during severe disease.
Aliases: lung, liver, or GI involvement, lung, liver, or gastrointestinal (GI) involvement
- moderate cgvhd
An intermediate cGVHD severity category used for subgroup comparison.
Aliases: moderate chronic graft-versus-host disease
- overall survival
The time-to-death endpoint used to assess patient survival after transplantation.
Aliases: OS
- peripheral blood stem cell graft
A stem cell graft sourced from peripheral blood rather than another donor source.
Aliases: PBSC graft
- platelet count below 100/nl
A low platelet count measured at the time cGVHD began and used as a prognostic stratifier.
Aliases: platelet count of less than 100/nL
- progressive onset
A cGVHD onset pattern in which disease progresses from a preceding acute phase.
Aliases: progressive onset of cGVHD
- quiescent onset
A cGVHD onset pattern in which chronic disease follows a quiet interval after acute graft-versus-host disease.
Aliases: quiescent onset of cGVHD
- severe cgvhd
The most advanced cGVHD severity category analyzed in the study.
Aliases: severe chronic graft-versus-host disease
- transplantation-related mortality
Death attributable to complications of transplantation rather than disease relapse, used as an outcome measure.
Aliases: TRM
REFERENCES
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