Overlap chronic GVHD is associated with adverse survival outcomes compared to classic chronic GVHD.
Lev GorfinkelSharmila RaghunandanBenjamin WatkinsKyle HebertDonna S NeubergBrandi BratrudeKayla BetzAlison YuSung Won ChoiJeffrey DavisChristine DuncanRoger GillerMichael S GrimleyAndrew C HarrisDavid JacobsohnNahal LalefarNosha FarhadfarMichael A PulsipherShalini ShenoyAleksandra PetrovicKirk R SchultzGregory A YanikBruce R BlazarJohn T HoranAmelia A LangstonLeslie S KeanMuna QayedPublished in: Bone marrow transplantation (2024)
Chronic graft-versus-host-disease (cGVHD) is divided into two subtypes: classic (absence of acute GVHD features) and overlap cGVHD ('ocGVHD'), in which both chronic and acute GVHD clinical features are present simultaneously. While worse outcomes with ocGVHD have been reported, there are few recent analyses. We performed a secondary analysis of data from the ABA2 trial (N = 185), in which detailed GVHD data were collected prospectively and systematically adjudicated. Analyses included cumulative incidence of classic versus ocGVHD, their specific organ manifestations, global disease severity scores, non-relapse mortality (NRM), disease-free survival (DFS) and overall survival (OS) in these two cGVHD subtypes. Of 92 patients who developed cGVHD, 35 were classified as ocGVHD. The 1-year cumulative incidence, organ involvement, and global severity of classic and ocGVHD were similar between ABA2 patients receiving CNI/MTX+placebo and CNI/MTX+abatacept; thus, cohorts were combined for ocGVHD evaluation. This analysis identified ocGVHD as having significantly higher severity at presentation and at maximum global severity compared to classic cGVHD. OS and DFS were significantly lower for ocGVHD versus classic cGVHD. OcGVHD is associated with increased cGVHD severity scores, and is associated with decreased OS and DFS compared to classic cGVHD, underscoring the high risks with this cGVHD subtype.
Keyphrases
- free survival
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- risk factors
- transcription factor
- rheumatoid arthritis
- clinical trial
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- emergency department
- respiratory failure
- randomized controlled trial
- study protocol
- acute lymphoblastic leukemia
- big data
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- machine learning
- aortic dissection
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- case report
- data analysis
- phase ii
- rheumatoid arthritis patients
- disease activity
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