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Disease Progression, Treatment Patterns, Hospitalization, and Clinical Outcomes of Patients with Acute Graft-Versus-Host Disease (aGVHD) after Allogeneic Hematopoietic Stem Cell Transplant (HSCT): A Multicenter Chart Review

Year: 2020

Type: article

Abstract: Introduction aGVHD is a significant cause of morbidity and mortality following allogeneic HSCT. Objectives To describe the clinical course, treatments, hospitalizations, and clinical outcomes of patients who developed aGVHD after HSCT. Methods A multicenter retrospective chart review was conducted at 11 large US academic and community transplant centers to identify patients with first allo HSCT from 1/1/2014–6/30/2016 who subsequently developed grade II–IV aGVHD. Changes in aGVHD grade or organs involved, aGVHD recurrence, inpatient resource utilization, all-cause mortality, and 12-month overall and nonrelapse mortality (NRM) based on Kaplan-Meier estimates were reported. Results Data were collected for 475 patients (mean age, 52 years; 57% male). Median (interquartile range [IQR]) time from transplant to aGVHD diagnosis was 32 (22–48) days. At time of diagnosis, most (63%) patients had grade II disease (Figure 1), and 33% had ≥2 organs involved. Among all patients, 29% had an increase in their aGVHD grade, with a median time of 19 days from diagnosis to max grade. At max aGVHD grade, 46% had ≥2 organs involved (Figure 2). Overall, an increase in grade, new organ involvement, and progression by either organ or grade was experienced by 29%, 27%, and 40% of patients, respectively. Among patients with grade II–IV at diagnosis (n=431), 73% (314) received systemic corticosteroids (CS) as initial therapy, and median (IQR) time from diagnosis to initiation of systemic CS was 0 (0–2) days. Median starting dose was 1.0 mg/kg (79 mg/day) for prednisone and 2.1 mg/kg (190 mg/day) for methylprednisolone. During follow-up (median [IQR] 524 [165–954] days from aGVHD diagnosis to death/last visit), 23% of patients had CS dose increases, and 44% were unable to taper below 10 mg/day. Upon tapering CS, aGVHD recurred in 199 of 475 (42%) and was managed in 51% by increasing CS doses. 89 patients received additional systemic therapy for GVHD; 42% increased CS dose before additional therapy. Overall, 55% of patients required hospital readmission(s) within 100 days post-HSCT (mean length of stay, 27.5 days). Relapse of the underlying malignancy was reported in 110 (23%) patients. The 12-month overall mortality and NRM rates were 35% and 26%, respectively. Overall, 53% of patients died at a median (IQR) of 213 (77–430) days from aGVHD diagnosis (Figure 3). Conclusion 40% of patients with aGVHD experienced progression of GVHD despite systemic treatment; 27% with grade II progressed to higher grade. Approximately half of all patients required readmissions for inpatient stays of almost a month. Half of those patients died within 7 months of aGVHD onset. Although patients with grade III–IV aGVHD had the worst outcomes, patients with grade II at onset also had high mortality rates (51%). These data indicate the need for effective and tolerable treatments administered early in the disease course, even for grade II aGVHD.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2019.12.742