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. 2024 Aug 27;8(16):4250-4261.
doi: 10.1182/bloodadvances.2024013442.

Associations between acute and chronic graft-versus-host disease

Masaharu Tamaki  1   2 , Yu Akahoshi  1   3 , Yoshihiro Inamoto  4 , Kaoru Morita  5 , Naoyuki Uchida  6 , Noriko Doki  7 , Masatsugu Tanaka  8 , Tetsuya Nishida  9 , Hiroyuki Ohigashi  10 , Hirohisa Nakamae  11 , Makoto Onizuka  12 , Yuta Katayama  13 , Ken-Ichi Matsuoka  14 , Masashi Sawa  15 , Fumihiko Ishimaru  16 , Yoshinobu Kanda  1   5 , Takahiro Fukuda  17 , Yoshiko Atsuta  18   19 , Seitaro Terakura  20 , Junya Kanda  21
Affiliations

Associations between acute and chronic graft-versus-host disease

Masaharu Tamaki et al. Blood Adv. .

Abstract

Chronic graft-versus-host disease (GVHD) is 1 of the major complications after allogeneic hematopoietic cell transplantation (allo-HCT). Although various risk factors for chronic GVHD have been reported, limited data are available regarding the impact of acute GVHD on chronic GVHD. We examined the association between acute and chronic GVHD using a Japanese registry data set. 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, 14 618 and 6135 patients who underwent allo-HCT with bone marrow or peripheral blood (BM/PB) and with umbilical cord blood (UCB), respectively, were analyzed. In the BM/PB cohort, the risk for chronic GVHD that requires systemic steroids increased with each increase in acute GVHD grade from 0 to 2 (grade 0 vs 1 [hazard ratio (HR), 1.32; 95% confidence interval (CI), 1.19-1.46; P < .001]; grade 1 vs 2 [HR, 1.41; 95% CI, 1.28-1.56; P < .001]), but the risk was similar between acute GVHD grade 2 and grade 3 to 4 (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 for severe chronic GVHD increased with each increment in the grade of acute GVHD, even between acute GVHD grade 2 and grade 3 to (grade 2 vs 3-4: HR, 1.70; 95% CI, 1.12-2.58; P = .025). In conclusion, the preceding profiles of acute GVHD should help to stratify the risk for chronic GVHD and its severity, which might be useful for the development of risk-adopted preemptive strategies for chronic GVHD.

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Conflict of interest statement

Conflict-of-interest disclosure: M. Tamaki reports receiving honoraria from Astellas Pharma and Kyowa Kirin. Y. Kanda reports receiving honoraria from Pfizer, Sumitomo Pharma, Novartis Pharma, Sanofi K.K., Chugai Pharmaceutical, SymBio Pharmaceuticals, Bristol Myers Squibb, Janssen Pharmaceutical K.K., Asahi Kasei Pharma, MSD, Astellas Pharma, Kyowa Kirin; and subsidies from Sumitomo Pharma, Chugai Pharmaceutical, Kyowa Kirin, and Eisai. The remaining authors declare no competing financial interests.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Cumulative incidence of chronic GVHD requiring systemic steroids. (A) BM/PB cohort. (B) UCB cohort. The plots show the results using Gray’s test.
Figure 2.
Figure 2.
Associations between acute and each subtype of chronic GVHD. (A) Chronic GVHD requiring systemic steroids in the BM/PB cohort. (B) Chronic GVHD requiring systemic steroids in the UCB cohort. (C) Lung chronic GVHD. (D) Extensive skin chronic GVHD. (E) NIH criteria–based moderate or severe chronic GVHD in the BM/PB cohort. (F) NIH criteria–based severe chronic GVHD in the BM/PB cohort. Ref, reference.
Figure 3.
Figure 3.
Cumulative incidence of each subtype of chronic GVHD in the BM/PB cohort. (A) Lung chronic GVHD. (B) Extensive skin chronic GVHD. (C) NIH criteria–based moderate or severe chronic GVHD. (D) NIH criteria–based severe chronic GVHD. The plots show the results using Gray’s test.
See this image and copyright information in PMC

References

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