GVHD prophylaxis and incidence in contemporary alloHSCT: a large real-world GETH/TC analysis
Year: 2026
Type: article
Study design: Observational Study
Abstract: Graft-versus-host disease (GVHD) remains a major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (alloHSCT). Although post-transplant cyclophosphamide (PTCy) and antithymocyte globulin (ATG) have reshaped prophylactic strategies, contemporary real-world data on GVHD incidence under current practice are limited. We conducted a nationwide retrospective study including 1 544 alloHSCTs performed in Spain (2018-2020) to characterize current prophylaxis patterns and the epidemiology of GVHD. PTCy-based prophylaxis was used in 65.6% of transplants, being nearly universal in haploidentical donors (96.9%) and predominant in mismatched unrelated (72.4%), matched unrelated (58.6%), and matched related donors (43.5%). The cumulative incidence of acute GVHD grades II-IV was 28.4% at day +100 and 30.7% at 1 year; grade III-IV occurred in 6.9% and 8.0%, respectively. Chronic GVHD at 2 years was 36.7%, with 23.5% moderate-to-severe cases. Acute GVHD was independently associated with inferior survival (HR 2.40, p<0.001), particularly grade III-IV disease (HR 4.34, p<0.001). These findings define the contemporary real-world burden of GVHD in a high-volume European country and provide an updated epidemiologic framework to inform preventive strategies, clinical trial design, and healthcare planning in modern alloHSCT.
Source: Bone Marrow Transplantation
Authors: Carmen Martínez, Leyre Bento, María Queralt Salas, Juan Montoro, Jaime Sanz, Lucia López Corral, Estefanía Pérez López, María Jesús Pascual, Irene García-Cadenas, María Suarez-Lledó, Arancha Bermúdez, Felipe Peña, Carlos Carretero, María-José Jiménez Lorenzo, Pedro Antonio González-Sierra, Antonia Sampol, Inmaculada Heras, Teresa Zudaire, Silvia Filaferro, Ángel Cedillo, Pascual Balsalobre, Carlos Solano, Manuel Jurado
Institutions: Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Fundació de Recerca Clínic Barcelona-Institut d’Investigacions Biomèdiques August Pi i Sunyer, Health Research Institute of the Balearic Islands, Hospital Universitario Son Espases, Fundació Clínic per a la Recerca Biomèdica, Universitat de València, Hospital Universitari i Politècnic La Fe, Centro de Investigación Biomédica en Red de Cáncer, Universidad de Salamanca, Instituto de Investigación Biomédica de Salamanca, Centro de Investigación del Cáncer, Hospital Regional Universitario de Málaga, Hospital de Sant Pau, Marqués de Valdecilla University Hospital, Institut d'Investigació Biomédica de Bellvitge, Institut Català d'Oncologia, Hospital Clínico Universitario de Valencia, Universitat Autònoma de Barcelona, Josep Carreras Leukaemia Research Institute, Hospital Universitari Germans Trias i Pujol, Hospital Universitario Virgen de las Nieves, Hospital General Universitario Morales Meseguer, Complejo Hospitalario de Navarra, Grupo Español de Trasplante Hematopoyético y Terapia Celular
Language: English
Subfield: Hematology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funder: Novartis Farmacéutica
OpenAlex ID: W7213468511