Journal Article

Overlap chronic GVHD is associated with adverse survival outcomes compared to classic chronic GVHD

Jacobsohn, David, Giller, Roger, Lalefar, Nahal, Betz, Kayla, Kean, Leslie S., Schultz, Kirk R., Harris, Andrew C., Pulsipher, Michael A., Duncan, Christine, Gorfinkel, Lev, Yu, Alison, Qayed, Muna, Raghunandan, Sharmila, Petrovic, Aleksandra, Neuberg, Donna S., Bratrude, Brandi, Grimley, Michael, Watkins, Benjamin, Blazar, Bruce R., Davis, Jeffrey, Yanik, Gregory A., Horan, John T., Langston, Amelia, Choi, Sung W., Farhadfar, Nosha, Shenoy, Shalini, Hebert, Kyle

2024

Overview

Chronic graft-versus-host-disease (cGVHD) is divided into two subtypes: classic (absence of acute GVHD features) and overlap cGVHD (‘ocGVHD’), in which both chronic and acute GVHD clinical features are present simultaneously. While worse outcomes with ocGVHD have been reported, there are few recent analyses. We performed a secondary analysis of data from the ABA2 trial ( N  = 185), in which detailed GVHD data were collected prospectively and systematically adjudicated. Analyses included cumulative incidence of classic versus ocGVHD, their specific organ manifestations, global disease severity scores, non-relapse mortality (NRM), disease-free survival (DFS) and overall survival (OS) in these two cGVHD subtypes. Of 92 patients who developed cGVHD, 35 were classified as ocGVHD. The 1-year cumulative incidence, organ involvement, and global severity of classic and ocGVHD were similar between ABA2 patients receiving CNI/MTX+placebo and CNI/MTX+abatacept; thus, cohorts were combined for ocGVHD evaluation. This analysis identified ocGVHD as having significantly higher severity at presentation and at maximum global severity compared to classic cGVHD. OS and DFS were significantly lower for ocGVHD versus classic cGVHD. OcGVHD is associated with increased cGVHD severity scores, and is associated with decreased OS and DFS compared to classic cGVHD, underscoring the high risks with this cGVHD subtype.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 692/499 / 692/699/249/1529 / Adult / Aged / Blood diseases / Cancer therapies / Cell Biology / Chronic Disease / Disease-Free Survival / Female / Graft versus host disease / Graft vs Host Disease - mortality / Graft-versus-host reaction / Hematology / Hematopoietic Stem Cell Transplantation - adverse effects / Hospitals / Humans / Internal Medicine / Male / Medicine / Medicine & Public Health / Middle Aged / Patients / Public Health / Secondary analysis / Stem Cells / Survival / Survival Rate / Transplants & implants