Researchers identified several risk factors for chronic graft-versus-host disease (GVHD) in patients who received allogeneic haploidentical hematopoietic stem-cell transplantation (HSCT) with posttransplant cyclophosphamide, according to research presented at the Tenth Annual Meeting of the Society of Hematologic Oncology (SOHO).
Marta Fonseca Santos, MD, of the Hospital Universitario de Salamanca in Spain, and colleagues conducted the research and presented it at the SOHO meeting.
Chronic GVHD “is a relevant cause of late morbidity and mortality related to allogeneic stem-cell transplantation in long-term survivors,” Dr. Fonseca Santos and colleagues wrote. “GVHD prophylaxis using posttransplantation cyclophosphamide has improved haploidentical stem-cell transplantation outcomes; however, data related to characteristics, risk factors, or [chronic] GVHD outcomes are limited.”
The researchers conducted a retrospective multicenter analysis of 389 patients who underwent haploidentical HSCT with posttransplant cyclophosphamide at 7 transplant centers in Spain between 2007 and 2020. The median patient age was 48 years (range, 5-74 years) and most patients were male (62%). Acute myeloid leukemia (37%) and Hodgkin lymphoma (22%) were the most common hematologic malignancies in the group of patients studied. More than a third of patients (36%) previously received a transplant.
The cumulative incidence of acute GVHD was 66% at day 180 after transplant, while the cumulative incidence of acute GVHD grades 3 to 4 was 20% at that time point. Chronic GVHD occurred in 95 patients (24.4%). The cumulative incidence of chronic GVHD at 3 years after transplant was 34%, while the cumulative incidence of moderate-to-severe chronic GVHD was 10% at that time point. Systemic treatment was required in 42 patients (10.7%).
The 2-year GVHD-free survival rate was 45%, while the 2-year overall survival (OS) rate was 59% and the 2-year progression-free (PFS) survival rate was 54%.
Researchers identified in a univariate analysis several risk factors for chronic GVHD in patients who were alive on day 100 after transplant. The risk factors included having a female donor (P=.034), being a male recipient of a female donor (P=.041), receiving myeloablative conditioning (P=.047), previously having acute GVHD (P=.014), and receiving radiotherapy conditioning (P=.004). Busulfan conditioning was a protective factor against developing chronic GVHD (P=.036).
The risk of developing chronic GVHD remained significantly elevated in those with previous acute GVHD in a multivariate analysis (P=.031), as did the protective effect of busulfan conditioning (P=.036).
Patients with moderate chronic GVHD had a higher OS rate (P=.054), higher PFS rate (P=.004), and lower relapse rate than other groups of patients (P=.035). The use of bone marrow in transplant and receiving 1 line of treatment were risk factors in these patients.
The use of haploidentical HSCT with posttransplant cyclophosphamide “represents an alternative for some patients,” Dr. Fonseca Santos and colleagues concluded. “The development of moderate [chronic] GVHD is a protective factor in this transplant modality. The characterization of predictive factors of this subgroup is relevant given the results.”
Fonseca Santos M, Bailen Almorox R, Solan L, et al. Incidence and characteristics of chronic GVHD in haploidentical stem-cell transplantation with post-transplantation cyclophosphamide: experience of the Spanish group of hematopoietic transplantation and cell therapy (GETH-TC). Poster CT-275. Presented at the Tenth Annual Meeting of the Society of Hematologic Oncology; September 28-October 1, 2022; Houston, TX.