Chronic graft-versus-host disease in long-term survivors of childhood leukemia

Hematopoietic stem cell transplantation (HSCT) is a curative treatment for high-risk childhood leukemia but may lead to chronic graft-versus-host disease (cGvHD), a severe long-term complication. This study analyzed data from the LEA cohort, including 446 childhood leukemia survivors treated with allogeneic HSCT. The standardized cGvHD evaluation, using the NIH consensus criteria, was conducted 8.7 ± 0.3 years post-HSCT. Long-term cGvHD was reported in 21% of patients (9% mild, 7% moderate, 5% severe), primarily affecting eyes, skin, lungs, and mouth, with some cases involving multiple organs. Most patients with long-term cGvHD were untreated (84%), while 11% received systemic and 5% local treatments. cGvHD was associated with other long-term complications. Administration of anti-thymocyte globulin was a significant determinant (OR 0.6, 95% CI 0.4-0.99, P = 0.045). Long-term cGvHD showed a marked detrimental effect on the quality of life (QoL), even after adjusting for the other long-term complications. The SF-36 physical and psychological adjusted composite scores in patients with versus without cGvHD were 50 ± 2 versus 55 ± 1 (P = 0.01) and 38 ± 2 versus 43 ± 1 (P = 0.01), respectively. Even mild and moderate forms significantly affected the QoL, especially on psychological dimensions. These findings support standardized cGvHD evaluation and management to improve long-term outcomes of transplanted childhood leukemia survivors.