Associations between acute and chronic graft-versus-host disease.
Masaharu TamakiYu AkahoshiYoshihiro InamotoKaoru MoritaNaoyuki UchidaKazuteru OhashiMasatsugu TanakaTetsuya NishidaHiroyuki OhigashiHirohisa NakamaeMakoto OnizukaYuta KatayamaKen-Ichi MatsuokaMasashi SawaFumihiko IshimaruYoshinobu KandaTakahiro FukudaYoshiko AtsutaSeitaro TerakuraJunya KandaPublished in: Blood advances (2024)
Chronic graft-versus-host disease (GVHD) is one of the major complications after allogeneic hematopoietic cell transplantation (allo-HCT). While various risk factors for chronic GVHD have been reported, limited data is available regarding the impact of acute GVHD on chronic GVHD. We examined the association between acute and chronic GVHD using a Japanese registry dataset. The landmark point was set at day 100 after allo-HCT and patients who died or relapsed before the landmark point were excluded. In total, 14618 and 6135 patients who underwent allo-HCT with bone marrow or peripheral blood (BM/PB) and umbilical cord blood (UCB) were analyzed. In the BM/PB cohort, the risk of chronic GVHD requiring systemic steroids increased with each increase within grade 0-II acute GVHD (Grade 0 vs. I: HR, 1.32, 95% CI, 1.19-1.46, P < 0.001; Grade I vs. II: HR, 1.41, 95% CI, 1.28-1.56, P < 0.001), but the risk was similar between grade II and III-IV acute GVHD (HR, 1.02; 95% CI, 0.91-1.15; P = 1.0). These findings were confirmed in the UCB cohort. We further observed that the risk of severe chronic GVHD increased with each increment in the grade of acute GVHD, even between Grades II and III-IV acute GVHD (Grade II vs. III-IV: HR, 1.70; 95% CI, 1.12-2.58; P = 0.025). In conclusion, the preceding profiles of acute GVHD should help to stratify the risk of chronic GVHD and its severity, which might be useful for the development of risk-adopted pre-emptive strategies for chronic GVHD.
Keyphrases
- allogeneic hematopoietic stem cell transplantation
- drug induced
- liver failure
- respiratory failure
- bone marrow
- aortic dissection
- acute lymphoblastic leukemia
- acute myeloid leukemia
- mesenchymal stem cells
- peripheral blood
- hepatitis b virus
- umbilical cord
- end stage renal disease
- chronic kidney disease
- stem cell transplantation
- machine learning
- cell death
- risk assessment
- early onset
- heavy metals
- mechanical ventilation
- electronic health record
- patient reported outcomes
- cell cycle arrest
- multiple myeloma
- peritoneal dialysis
- aqueous solution