AUTHOR=Langer Ronja , Lelas Antonela , Rittenschober Michael , Piekarska Agnieszka , Sadowska-Klasa Alicja , Sabol Ivan , Desnica Lana , Greinix Hildegard , Dickinson Anne , Inngjerdingen Marit , Lawitschka Anita , Vrhovac Radovan , Pulanic Drazen , Güneş Sibel , Klein Stefan , Moritz Middeke Jan , Grube Matthias , Edinger Matthias , Herr Wolfgang , Wolff Daniel 

TITLE=Retrospective analysis of the incidence and outcome of late acute and chronic graft-versus-host disease—an analysis from transplant centers across Europe

JOURNAL=Frontiers in Transplantation

VOLUME=3

YEAR=2024

URL=https://www.frontiersin.org/journals/transplantation/articles/10.3389/frtra.2024.1332181

DOI=10.3389/frtra.2024.1332181

ISSN=2813-2440

ABSTRACT=<sec><title>Introduction</title><p>Chronic graft-versus-host disease (cGvHD) is a serious late complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT).</p></sec><sec><title>Methods</title><p>This multicenter analysis determined the cumulative incidence (CI) of cGvHD and late acute GvHD (laGvHD) and its impact on transplantation-related mortality (TRM), relapse (R), and overall survival (OS) in 317 patients [296 adults, 21 pediatrics (&lt;12 years of age)] who underwent their first allo-HSCT in 2017.</p></sec><sec><title>Results</title><p>The CI of laGvHD was 10.5% in adults and 4.8% in pediatrics, and the CI of cGvHD was 43.0% in all adult transplant patients and 50.2% in the adult at-risk cohort at the study end. The onset of cGvHD was <italic>de novo</italic> in 42.0% of patients, quiescent in 52.1%, and progressive in 5.9%. In adults, prophylactic use of antithymocyte globulin or posttransplant cyclophosphamide was associated with a significantly lower incidence of cGvHD (28.7%) vs. standard prophylaxis with calcineurin inhibitors (30.6%) and methotrexate/mycophenolate mofetil (58.4%) (all <italic>p </italic>&lt; 0.01). TRM was significantly higher in patients with aGvHD (31.8%) vs. cGvHD (12.6%) and no GvHD (6.3%) (all <italic>p </italic>= 0.0001). OS in the adult at-risk cohort was significantly higher in patients with cGvHD (78.9%) vs. without (66.2%; <italic>p </italic>= 0.0022; HR 0.48) due to a significantly lower relapse rate (cGvHD: 14.5%; without cGvHD: 27.2%; <italic>p </italic>= 0.00016, HR 0.41). OS was also significantly higher in patients with mild (80.0%) and moderate (79.2%) cGvHD vs. without cGvHD (66.2%), excluding severe cGvHD (72.7%) (all <italic>p </italic>= 0.0214).</p></sec><sec><title>Discussion</title><p>The negative impact of severe cGvHD on OS suggests a focus on prevention of severe forms is warranted to improve survival and quality of life.</p></sec>