Incidence, clinical presentation, risk factors, outcomes, and biomarkers in de novo late acute GVHD

• Type of Material: Article
• Authors: Yu Akahoshi, Icahn School of Medicine at Mount Sinai; Nikolaos Spyrou, Icahn School of Medicine at Mount Sinai; William J. Hogan, Mayo Clinic; Francis Ayuk, University Medical Center Hamburg-Eppendorf; Zachariah DeFilipp, Massachusetts General Hospital; Muna Qayed, Emory University; John E. Levine, Icahn School of Medicine at Mount Sinai; James L. M. Ferrara, Icahn School of Medicine at Mount Sinai; Yi-Bin Chen, Massachusetts General Hospital
• Language: English
• Date: 2023-08-22
• Publisher: ELSEVIER
• Publication Version: Final Published Version
• Copyright Statement: © 2023 by The American Society of Hematology.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1182/bloodadvances.2023009885
• Title of Journal or Parent Work: BLOOD ADVANCES
• Volume: 7
• Issue: 16
• Start Page: 4479
• End Page: 4491
• Grant/Funding Information: This work was supported by the National Institutes of Health, National Cancer Institute grant PO1CA03942, the Pediatric Cancer Foundation, and the German Jose Carreras Leukemia Foundation (DJCLS 01 GVHD 2016 and DJCLS 01 GVHD 2020).
• Keywords: CONSENSUS DEVELOPMENT PROJECT; TRANSPLANTATION; CRITERIA; SURVIVAL; INITIAL THERAPY; CLASSIFICATION; Hematology; Life Sciences & Biomedicine; DOSE PREDNISONE; Science & Technology; DIAGNOSIS; VERSUS-HOST-DISEASE; CHRONIC GRAFT
• Research Categories: Health Sciences, Medicine and Surgery

Abstract

Late acute graft-versus-host disease (GVHD) is defined as de novo acute GVHD presenting beyond 100 days after allogeneic hematopoietic cell transplantation (HCT) without manifestations of chronic GVHD. Data are limited regarding its characteristics, clinical course, and risk factors because of underrecognition and changes in classification. We evaluated 3542 consecutive adult recipients of first HCTs at 24 Mount Sinai Acute GVHD International Consortium (MAGIC) centers between January 2014 and August 2021 to better describe the clinical evolution and outcomes of late acute GVHD. The cumulative incidence of classic acute GVHD that required systemic treatment was 35.2%, and an additional 5.7% of patients required treatment for late acute GVHD. At the onset of symptoms, late acute GVHD was more severe than classic acute GVHD based on both clinical and MAGIC algorithm probability biomarker parameters and showed a lower overall response rate on day 28. Both clinical and biomarker grading at the time of treatment stratified the risk of nonrelapse mortality (NRM) in patients with classic and late acute GVHD, respectively, but long-term NRM and overall survival did not differ between patients with classic and late acute GVHD. Advanced age, female-to-male sex mismatch, and the use of reduced intensity conditioning were associated with the development of late acute GVHD, whereas the use of posttransplant cyclophosphamide–based GVHD prevention was protective mainly because of shifts in GVHD timing. Because overall outcomes were comparable, our findings, although not definitive, suggest that similar treatment strategies, including eligibility for clinical trials, based solely on clinical presentation at onset are appropriate.