Prognostic factors and long-term follow-up of basiliximab for steroid-refractory acute GVHD: updated experienced from a large-scale study.

Acute graft-versus-host disease (aGVHD) is one of the most important causes of early mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT), particularly for those with steroid-refractory (SR)-aGVHD. We aimed to identify the prognostic factors and long-term clinical outcomes of basiliximab treatment for SR-aGVHD. Basiliximab was administered on days 1 and 3, and repeated weekly until aGVHD was less than grade II or patients showed no response after 4 doses. Out of 1498 consecutive patients receiving allo-HSCT, 230 patients with SR-aGVHD were enrolled. Grade III to IV aGVHD before basiliximab treatment significantly and independently predicted a poorer response to basiliximab in multivariate analysis, and the cumulative incidence of overall response at 14 days, 28 days, and 56 days after treatment was 41.4 % versus 23.1% (P=0.023), 70.2% versus 43.6% (P=0.002), and 80.1% versus 66.7% (P=0.013), respectively, for those with grade II and grade III to IV aGVHD. Patients receiving more than 4 doses of basiliximab had higher rates of infections. The 4-year cumulative incidence of total and severe chronic GVHD after basiliximab treatment was 44.8% (95% CI 38.3-51.3%) and 2.2% (95% CI 0.3-4.1%), respectively. The 4-year cumulative incidence of relapse, non-relapse mortality, disease-free survival, and overall survival after basiliximab treatment was 11.3% (95% CI 7.2-15.4%), 30.0% (95% CI 24.1-35.9%), 58.7% (95% CI 52.3-65.1%), and 61.7% (95% CI 55.4-68.0%), respectively. Comorbidities before allo-HSCT and refined Minnesota aGVHD risk score at diagnosis had significant influences on long-term survival. Thus, basiliximab was a safe and effective treatment for patients with SR-aGVHD. This article is protected by copyright. All rights reserved. This article is protected by copyright. All rights reserved.