Incidence, clinical presentation, risk factors, outcomes, and biomarkers in de novo late acute GVHD

Akahoshi Y, Spyrou N, Hogan WJ, Ayuk F, DeFilipp Z, Weber D, Choe HK, Hexner EO, Rösler W, Etra AM, Sandhu K, Yanik GA, Chanswangphuwana C, Kitko CL, Reshef R, Kraus S, Wölfl M, Eder M, Bertrand H, Qayed M, Merli P, Grupp SA, Aguayo-Hiraldo P, Schechter T, Ullrich E, Baez J, Beheshti R, Gleich S, Kowalyk S, Morales G, Young R, Kwon D, Nakamura R, Levine JE, Ferrara JL, Chen YB (2023)

Publication Type: Journal article

Publication year: 2023

Journal

Book Volume: 7

Pages Range: 4479-4491

Journal Issue: 16

DOI: 10.1182/bloodadvances.2023009885

Abstract

Late acute graft-versus-host disease (GVHD) is defined as de novo acute GVHD presenting beyond 100 days after allogeneic hematopoietic cell transplantation (HCT) without manifestations of chronic GVHD. Data are limited regarding its characteristics, clinical course, and risk factors because of underrecognition and changes in classification. We evaluated 3542 consecutive adult recipients of first HCTs at 24 Mount Sinai Acute GVHD International Consortium (MAGIC) centers between January 2014 and August 2021 to better describe the clinical evolution and outcomes of late acute GVHD. The cumulative incidence of classic acute GVHD that required systemic treatment was 35.2%, and an additional 5.7% of patients required treatment for late acute GVHD. At the onset of symptoms, late acute GVHD was more severe than classic acute GVHD based on both clinical and MAGIC algorithm probability biomarker parameters and showed a lower overall response rate on day 28. Both clinical and biomarker grading at the time of treatment stratified the risk of nonrelapse mortality (NRM) in patients with classic and late acute GVHD, respectively, but long-term NRM and overall survival did not differ between patients with classic and late acute GVHD. Advanced age, female-to-male sex mismatch, and the use of reduced intensity conditioning were associated with the development of late acute GVHD, whereas the use of posttransplant cyclophosphamide–based GVHD prevention was protective mainly because of shifts in GVHD timing. Because overall outcomes were comparable, our findings, although not definitive, suggest that similar treatment strategies, including eligibility for clinical trials, based solely on clinical presentation at onset are appropriate.

Authors with CRIS profile

Involved external institutions

Icahn School of Medicine at Mount Sinai United States (USA) (US) Mayo Clinic United States (USA) (US) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE) Massachusetts General Hospital United States (USA) (US) Universität Regensburg Germany (DE) Ohio State University United States (USA) (US) Penn Medicine United States (USA) (US) City of Hope Medical Center United States (USA) (US) University of Michigan United States (USA) (US) King Chulalongkorn Memorial Hospital / โรงพยาบาลจุฬาลงกรณ์ Thailand (TH) Vanderbilt University United States (USA) (US) Columbia University Irving Medical Center (CUIMC) United States (USA) (US) Universitätsklinikum Würzburg Germany (DE) Medizinische Hochschule Hannover (MHH) / Hannover Medical School Germany (DE) Universitätsklinikum Freiburg Germany (DE) Georgia Institute of Technology United States (USA) (US) Ospedale Pediatrico Bambino Gesu Italy (IT) Children's Hospital of Philadelphia United States (USA) (US) Children's Hospital Los Angeles United States (USA) (US) The Hospital for Sick Children (SickKids) Canada (CA) Frankfurt Cancer Institute Germany (DE)

How to cite

APA:

Akahoshi, Y., Spyrou, N., Hogan, W.J., Ayuk, F., DeFilipp, Z., Weber, D.,... Chen, Y.B. (2023). Incidence, clinical presentation, risk factors, outcomes, and biomarkers in de novo late acute GVHD. Blood Advances, 7(16), 4479-4491. https://doi.org/10.1182/bloodadvances.2023009885

MLA:

Akahoshi, Yu, et al. "Incidence, clinical presentation, risk factors, outcomes, and biomarkers in de novo late acute GVHD." Blood Advances 7.16 (2023): 4479-4491.

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