Associations between acute and chronic graft-versus-host disease

Area of Science:

• Hematology
• Immunology
• Transplantation Medicine

Background:

• Chronic graft-versus-host disease (GVHD) is a significant complication following allogeneic hematopoietic cell transplantation (allo-HCT).
• Limited data exist on the influence of acute GVHD on the subsequent development of chronic GVHD.

Purpose of the Study:

• To investigate the association between the grade of acute GVHD and the risk of developing chronic GVHD.
• To determine if acute GVHD severity can stratify patients for chronic GVHD risk.

Main Methods:

• Analysis of a Japanese registry data set including 14,618 bone marrow/peripheral blood (BM/PB) and 6,135 umbilical cord blood (UCB) allo-HCT recipients.
• Landmark analysis at day 100 post-allo-HCT, excluding patients who died or relapsed before this point.
• Hazard ratios (HR) and confidence intervals (CI) were calculated to assess the association between acute and chronic GVHD grades.

Main Results:

• In the BM/PB cohort, increasing acute GVHD grades (0 to 2) correlated with a higher risk of chronic GVHD requiring systemic steroids (HR 1.32-1.41).
• The risk of chronic GVHD was similar between acute GVHD grades 2 and 3-4 (HR 1.02).
• The risk for severe chronic GVHD increased with higher acute GVHD grades, notably between grade 2 and grade 3-4 (HR 1.70).

Conclusions:

• The grade of acute GVHD is a significant predictor of chronic GVHD development and severity.
• Acute GVHD profiles can aid in stratifying patients at risk for chronic GVHD.
• These findings may inform the development of risk-adapted preemptive strategies for chronic GVHD.