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

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.
Competing Interests: DW received research funds from Novartis and honoraria from Amgen, Neovii, Novartis, Mallinckrodt, Behring, and Takeda. RV received honoraria from Novartis, Pfizer, Abbvie, and MSD. AL received honoraria from Novartis. JM received honoraria for participation in an advisory board from Novartis. HG received honoraria for participation in advisory boards and speakers' bureau from Gilead, Novartis, Neovii, Sanofi, Takeda, and Therakos. SG is an employee of Novartis Pharma AG. AP received honoraria from Alexion, BMS/Celgene, Pfizer, Novartis and Mallinckrodt. DP received honoraria from Novartis and Takeda. LD received honoraria from Novartis and Takeda. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
(© 2024 Langer, Lelas, Rittenschober, Piekarska, Sadowska-Klasa, Sabol, Desnica, Greinix, Dickinson, Inngjerdingen, Lawitschka, Vrhovac, Pulanic, Güneş, Klein, Moritz Middeke, Grube, Edinger, Herr and Wolff.)