Approximately 30%-60% of patients with hematological diseases who receive an allogeneic hematopoietic cell transplantation (HCT) develop acute graft-versus-host disease (aGVHD), making it a significant barrier to the efficacy of HCT. In a study, researchers characterized disease progression, treatments, hospitalizations, and clinical outcomes in patients with aGVHD. After their analysis, the study’s authors highlighted the poor prognosis in this population and the unmet need for effective treatments.
The chart review, which was published in Bone Marrow Transplantation, included 475 patients aged 12 years or older who developed grades II-IV aGVHD after undergoing their first HCT between January 2014 and June 2016. Reviewed data included patient demographics, clinical characteristics, and baseline aGVHD grade and organ involvement plus changes over time, recurrence, treatments, resource utilization, and all-cause, 12-month, and nonrelapse mortality.
Characterizing Acute GVHD Trends
Of the 431 patients with grades II-IV baseline aGVHD, 73.1% were treated with first-line systemic corticosteroids. Over a median follow-up of 524 days following diagnosis, 23.4% of the cohort required an increase in steroid dose, and 44.4% required at least 10 mg/day.
Of the full cohort, 190 (40.0%) patients developed more severe aGVHD or additional organ involvement. Additionally, 54.9% of patients had 1 or more hospital readmissions within 100 days of transplantation, and 22.3% of patients had 2 or more. The mean length of stay in readmissions was 27.5 days.
The study recorded that 52.8% of patients died during follow-up. From the date of diagnosis, the 1-year rate of overall mortality was 35.2% and nonrelapse mortality was 25.5%. A total of 41.9% of patients had aGVHD recurrence.
Researchers noted the study was limited by its retrospective design, possible differences in aGVHD parameters and outcomes across centers, and the difficulty in determining whether or not cause of death was directly related to aGVHD.
“These findings suggest that there is a need for effective and tolerable treatments administered early in the disease course of acute GVHD to prevent or reverse disease progression,” the authors concluded.