Disease progression, treatments, hospitalization, and clinical outcomes in acute GVHD: a multicenter chart review

Abstract

Acute graft-versus-host disease (GVHD) remains a barrier to successful allogeneic hematopoietic cell transplantation (HCT) outcomes. This multicenter, retrospective chart review describes disease progression, treatment patterns, hospitalizations, and clinical outcomes among 475 patients (≥12 years old) who developed grades II-IV acute GVHD after their first HCT (January 2014-June 2016). Median (interquartile range) age at HCT was 55 (44-63) years. From the date of acute GVHD diagnosis, 190 patients (40.0%) experienced progression to more severe disease and/or developed new organ involvement. Among 431 patients with grades II-IV acute GVHD at diagnosis, 73.1% received first-line systemic corticosteroids. During follow-up (median 524 days since acute GVHD diagnosis), 23.4% of patients had an increase in steroid dose and 44.4% were unable to taper below 10 mg/day. Over half of patients (54.9%) required ≥1 hospital readmission within 100 days post-HCT (≥2 readmissions in 22.3%); mean inpatient length of stay upon readmission was 27.5 days. Approximately half of patients (52.8%) died during follow-up; 1-year overall mortality from date of acute GVHD diagnosis and nonrelapse mortality rates were 35.2% and 25.5%, respectively. Overall, patients who developed acute GVHD following HCT had poor clinical outcomes, highlighting the unmet need for early and effective treatment strategies.

Fig. 1. Acute GVHD severity at diagnosis and maximum grade.

GVHD graft-versus-host disease, IQR interquartile range. *Maximum grade was unknown for 1 patient who had grade II acute GVHD at diagnosis. ^†Time from acute GVHD diagnosis to maximum grade. ^‡Patients may have remained at the same grade from diagnosis to maximum grade, but their disease progressed with new organ involved.

Fig. 2. Acute GVHD organs involved* at diagnosis and maximum grade.

GI gastrointestinal tract, GVHD graft-versus-host disease. *“Skin only” includes patients who only had skin involvement; “skin” includes patients who had skin involvement with/without acute GVHD in other organs.

Fig. 3. Patient deaths by acute GVHD severity and organs* involved at diagnosis.

GI gastrointestinal tract, GVHD graft-versus-host disease, IQR interquartile range. *Organ stage 1–4 was considered organ involvement; patients could have multiple organs involved. ^†Time from acute GVHD diagnosis to death. ^‡Patients who had grade I acute GVHD at diagnosis but whose disease progressed to a higher grade later. ^§A subset of patients who had grade II acute GVHD at diagnosis but whose disease progressed to a higher grade later. ^¶A subset of patients who had grade III acute GVHD at diagnosis but whose disease progressed to a higher grade later.