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Published on: March 17, 2020
Characterization of Chronic Graft-versus-host Disease After Haploidentical Stem Cell Transplantation With
Marta Fonseca-Santos1, Rebeca Bailen2, Oriana Lopez-Godino3
1Hematology Department, Hospital Universitario de Salamanca, IBSAL, CIBERONC, Centro de Investigación del Cáncer-IBMCC (USAL-CSIC), Salamanca, Spain.
Insights
Chronic graft-versus-host disease (cGVHD) is less common and severe after haploidentical allogeneic hematopoietic stem cell transplantation (haplo-HSCT) with posttransplant cyclophosphamide (PTCy). Moderate cGVHD in this setting correlates with improved survival and lower relapse rates.
Area of Science:
- Hematology
- Transplantation Immunology
- Oncology
Background:
- Chronic graft-versus-host disease (cGVHD) is a significant cause of morbidity and nonrelapse mortality following allogeneic hematopoietic stem cell transplantation (allo-HSCT).
- While haploidentical allo-HSCT (haplo-HSCT) with posttransplant cyclophosphamide (PTCy) shows promise in reducing cGVHD rates, comprehensive data on its clinical profile, risk factors, and outcomes remain limited.
Purpose of the Study:
- To analyze the incidence, clinical characteristics, risk factors, and outcomes of cGVHD in patients undergoing haplo-HSCT with PTCy.
- To compare cGVHD rates and severity with those reported for HLA-identical transplantation.
Main Methods:
- A retrospective multicenter analysis was conducted on 389 patients who received haplo-HSCT with PTCy between 2008 and 2020.
- Data on cGVHD incidence, clinical profile, risk factors, and patient outcomes were collected from seven transplant centers.
Main Results:
- The incidence and severity of cGVHD were lower compared to HLA-identical transplantation.
- Previous acute GVHD was the strongest predictor of cGVHD (P=0.031), while recipient age ≥60 years was protective (P=0.044).
- Patients with moderate cGVHD exhibited longer event-free survival (P=0.016) and lower relapse rates (P=0.036) at 3 years.
Conclusions:
- Haplo-HSCT with PTCy is associated with reduced incidence and severity of cGVHD compared to conventional prophylaxis.
- Moderate cGVHD in this context may indicate a stronger graft-versus-leukemia effect, leading to improved survival outcomes.
- Further prospective studies are warranted to validate these findings.
Background:
Chronic graft-versus-host disease (cGVHD) is a cause of late morbidity and nonrelapse mortality (NRM) after allogenic hematopoietic stem cell transplantation (allo-HSCT). Although studies evaluating haploidentical allo-HSCT (haplo-HSCT) using posttransplant cyclophosphamide (PTCy) demonstrate lower cGVHD rates, comprehensive data describing the clinical profile, risk factors, or outcomes of cGVHD within this platform are scarce.
Methods:
We conducted a retrospective multicenter analysis of 389 consecutive patients who underwent haplo-HSCT PTCy in 7 transplant centers of the Spanish Group Grupo Español de Trasplante Hematopoyético y Terapia Celular (GETH-TC) between 2008 and 2020 describing incidence, clinical profile, risk factors, and cGVHD outcomes.
Results:
Ninety-five patients of 389 developed cGVHD. Our data revealed that the incidence and severity of cGVHD are lower than those reported for HLA-identical transplantation with conventional prophylaxis and that the strongest predictor for cGVHD was previous acute GVHD ( P = 0.031). Also, recipient age ≥60 y ( P = 0.044) was protective against cGVHD. Moreover, patients with moderate cGVHD had longer event-free survival at 3 y than other patients ( P = 0.016) and a lower relapse rate at 3 y ( P = 0.036).
Conclusions:
Our results support the fact that the incidence and severity of cGVHD are lower than those reported for HLA-identical transplantation with conventional prophylaxis. In this series, patients who develop moderate cGVHD after haplo-HSCT PTCy had a higher overall survival and event-free survival, and lower relapse, suggesting higher graft-versus-leukemia effect. Although this is the largest series focused on characterizing cGVHD in haplo-HSCT PTCy, further prospective studies are needed to confirm the findings.
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