Incidence and Outcomes of cGVHD After aGVHD by Steroid Response State

By Dustin Samples - February 22, 2023

In a study presented at the 2023 Tandem Transplant & Cellular Therapy Meetings of the ASTCT and CIBMTR, researchers from the University of Minnesota, Twin Cities, Minnesota, sought to determine the factors influencing the development and course of chronic graft-versus-host disease (cGVHD) after either steroid-sensitive (SS), dependent (SD), or refractory (SR) acute GVHD (aGVHD) as opposed to de-novo cGVHD.

To do so, the team reviewed the records of patients treated at their institution from 2008-2016 for all graft types, donor sources, GVHD prophylaxis strategies, and conditioning regimens. The final analysis included 784 patients.

Of the study population, 99 developed SS-aGVHD, 96 had SD-aGVHD, 152 had SR-aGVHD, and 198 developed cGVHD. The cumulative incidence (CI) of mild-moderate cGVHD was highest after SD-aGVHD, while the CI of severe cGVHD was highest after SR-aGVHD. However, the 3-year CI of any cGVHD was highest after SD-aGVHD, followed by SR-, SS-, and no aGVHD. Age and cGVHD also demonstrated an independent association.

Overall survival was lowest in patients who developed cGVHD after having SR- or SS-aGVHD. Three-year cGVHD relapse-free survival was higher in those who had either no aGVHD or SS-GVHD. The same group had higher 3-year survival without relapse, death, or new treatment initiated more than 30 days from the onset of cGVHD.

Given their results, the team concluded that “aGVHD response states are important predictors of cGVHD outcomes,” and added, “Improved treatment of aGVHD may limit the incidence and morbidity of subsequent cGVHD.

Herzog S, Weisdorf DJ, Shanley R, et al. Chronic GVHD Following Steroid Sensitive, Dependent, and Refractory Acute GVHD: Incidence and Clinical Outcomes. Abstract #343. Presented at the 2023 Tandem Meetings of ASTCT and CIBMTR; February 15-19, 2023; Orlando, FL.

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