O Ringdén1, M Labopin2, B Sadeghi1, A Mailhol2, D Beelen3, Y Fløisand4, A Ghavamzadeh5, J Finke6, G Ehninger7, L Volin8, G Socié9, N Kröger10, G Stuhler11, A Ganser12, C Schmid13, S Giebel14, M Mohty2, A Nagler15. 1. Division of Therapeutic Immunology, Karolinska Institutet, Karolinska University Hospital Huddinge, Stockholm, Sweden. 2. Hôpital Saint Antoine, Paris, France. 3. University of Essen, Duisburg, Germany. 4. Department of Hematology, Oslo University Hospital, Rikshospitalet, Oslo, Norway. 5. Shariati Hospital, Hematology-Oncology and BMT Research, Tehran, Iran. 6. Department of Medicine-Hematology, Oncology, University of Freiburg, Freiburg, Germany. 7. Medizinische Klinik und Poliklinik 1, Universitätsklinikum Dresden, Dresden, Germany. 8. Comprehensive Cancer Center, Stem Cell Transplantation Unit, Helsinki University Hospital, Helsinki, Finland. 9. Department of Hematology - BMT, Hopital St. Louis, Paris, France. 10. Department of Stem cell Transplantation, University Hospital Eppendorf, Hamburg, Germany. 11. Deutsche Klinik für Diagnostik, KMT Zentrum, Wiesbaden, Germany. 12. Medical University Hannover, Hannover, Germany. 13. University of Munich, Munich, Germany. 14. Department of Bone Marrow Transplantation and Oncohematology, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, Poland. 15. Chaim Sheba Medical Center, Tel-Hashomer, Israel.
Abstract
BACKGROUND: Acute graft-versus-host disease (aGVHD) is a major complication of allogeneic haematopoietic stem cell transplantation (HSCT). With new promising therapies, survival may improve for severe aGVHD. OBJECTIVES: We wanted to analyze the long-term outcome in patients who survive severe aGVHD. METHODS: This study was a landmark analysis of 23 567 patients with acute Leukaemia who survived for more than 6 months after HSCT, 2002-2014. Patients alive after severe aGVHD (n = 1738) were compared to controls. RESULTS: Patients with severe aGVHD had higher non-relapse mortality (NRM) and higher rate of extensive chronic GVHD (cGVHD) than the controls (P < 10-5 ). The probability of relapse was significantly lower in the severe aGVHD group, but Leukaemia-free survival (LFS) and overall survival were significantly lower than for the controls (P < 10-5 ). Five-year LFS in patients with severe aGVHD was 49%, as opposed to 61% in controls with no or mild GVHD and 59% in patients with moderate GVHD. CONCLUSIONS: HSCT patients who survive severe aGVHD have higher risk of developing extensive cGVHD, a higher NRM, a lower relapse probability, and lower LFS than other HSCT patients. This study is a platform for outcome analysis in patients treated with novel therapies for acute GVHD.
BACKGROUND: Acute graft-versus-host disease (aGVHD) is a major complication of allogeneic haematopoietic stem cell transplantation (HSCT). With new promising therapies, survival may improve for severe aGVHD. OBJECTIVES: We wanted to analyze the long-term outcome in patients who survive severe aGVHD. METHODS: This study was a landmark analysis of 23 567 patients with acute Leukaemia who survived for more than 6 months after HSCT, 2002-2014. Patients alive after severe aGVHD (n = 1738) were compared to controls. RESULTS:Patients with severe aGVHD had higher non-relapse mortality (NRM) and higher rate of extensive chronic GVHD (cGVHD) than the controls (P < 10-5 ). The probability of relapse was significantly lower in the severe aGVHD group, but Leukaemia-free survival (LFS) and overall survival were significantly lower than for the controls (P < 10-5 ). Five-year LFS in patients with severe aGVHD was 49%, as opposed to 61% in controls with no or mild GVHD and 59% in patients with moderate GVHD. CONCLUSIONS: HSCT patients who survive severe aGVHD have higher risk of developing extensive cGVHD, a higher NRM, a lower relapse probability, and lower LFS than other HSCT patients. This study is a platform for outcome analysis in patients treated with novel therapies for acute GVHD.