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While there was no difference in the incidence of severe Stage 3-4 skin aGVHD between patients with haGVHD versus others (46% vs. 30%, I p i = 0.2), severe Stage 3-4 liver and gastrointestinal aGVHD were more frequent in patients with haGVHD (38% vs. 18%, I p i = 0.015; and 15% vs. 4%, I p i = 0.0002 respectively). (C) Cumulative incidence of severe National Institutes of Health (NIH) Stage 2-3 chronic GVHD gl Overall, we found a low incidence of haGVHD in our cohort, only 10.4% of patients with Grade II-IV aGVHD leading to a day 14 cumulative incidence of 2.7%. OS was comparable between patients with Grade II-IV haGVHD (53.9%, 95% CI 24.8%-76.0%) and patients with Grade II-IV aGVHD after day 14 (45.7%, 95% CI 35.4%-55.4%, I p i = 0.23) (Figure 1A). [Extracted from the article]

Objectives: This retrospective study analyzed the impact of early cyclosporine A (CsA) initiation (day −3) on the risk of acute graft‐vs‐host disease (aGvHD) after haploidentical hematopoietic cell transplantation (Haplo‐HCT) using post‐transplant cyclophosphamide. Methods: Sixty‐one consecutives patients who underwent Haplo‐HCT were analyzed. Results: At day +180, the cumulative incidences of grade II‐IV and grade III‐IV aGvHD were 39% and 18%, respectively. Patients having a lowest CsA concentration (<301 ng/mL; the cutoff value used to segregate the patients between low and high CsA concentrations) in the first week after Haplo‐HCT had a significantly higher risk of grade II‐IV aGvHD (P = 0.02), severe grade III‐IV aGvHD (P = 0.03), cGvHD (P = 0.02), and extensive cGvHD (P = 0.04). In multivariate analysis, a higher CsA concentration (≥301 ng/mL) during the first week following Haplo‐HCT was the only parameter significantly associated with a reduced risk of grade II‐IV and grade III‐IV aGvHD (RR = 0.21; P = 0.049 and RR < 0.001; P < 0.0001, respectively). We find no correlation between CsA concentration and relapse, non‐relapse mortality, progression‐free survival, GvHD‐free and progression‐free survival, or overall survival. Conclusions: CsA could be initiated early before Haplo‐HCT with achievement of high CsA concentration to reduce the risk of aGvHD without any detrimental effect on relapse. [ABSTRACT FROM AUTHOR]

Background aims: Corticosteroids are the standard first-line treatment for acute graft-versus-host disease (aGVHD), but they are associated with many complications, and less than half of patients have a sustained response. Methods: To improve outcomes, we performed a retrospective study to analyze the efficacy of the addition of extracorporeal photopheresis (ECP) to low-dose corticosteroids in 37 adult patients (median age, 57 years) with skin-predominant aGVHD (grade I, n = 17; grade II, n = 18; and grade III, n = 2). All patients received ECP in combination with 1 mg/kg prednisone (n = 26) or topical steroids (n = 11). Results: Overall response rate was 81% after a median of three ECP procedures (range, 2–8), including 22 complete responses (CR, 59%) and eight very good partial responses (VGPR, 22%). The 11 patients treated with topical corticosteroids achieved CR. Furthermore, 16 (62%) patients reached prednisone withdrawal at a median of 100 days (range, 42–174 days) after its initiation. Eighteen patients developed chronic GVHD (cGVHD); 11 of them (who were in CR of aGVHD) had a new-onset cGVHD, and seven experienced progressive cGVHD (five non-responding and two VGPR patients). A second-line immunosuppressive treatment was initiated in only five (14%) non-responding patients. With a median follow-up of 31 months (range, 6–57 months) 2-year overall survival and non-relapse mortality were 74% and 11%, respectively. Conclusions: Overall, the combination of low-dose corticosteroids and ECP appear to be safe and effective for first-line treatment of skin predominant aGVHD. [ABSTRACT FROM AUTHOR]