Overlap chronic GVHD is associated with adverse survival outcomes compared to classic chronic GVHD

Lev Gorfinkel, Sharmila Raghunandan, Benjamin Watkins, Kyle Hebert, Donna S. Neuberg, Brandi Bratrude, Kayla Betz, Alison Yu, Sung W. Choi, Jeffrey Davis, Christine Duncan, Roger Giller, Michael Grimley, Andrew C. Harris, David Jacobsohn, Nahal Lalefar, Nosha Farhadfar, Michael A. Pulsipher, Shalini Shenoy, Aleksandra PetrovicKirk R. Schultz, Gregory A. Yanik, Bruce R. Blazar, John T. Horan, Amelia Langston, Leslie S. Kean, Muna Qayed

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)680-687
Number of pages8
JournalBone marrow transplantation
Volume59
Issue number5
DOIs
StatePublished - May 2024

Bibliographical note

Publisher Copyright:
© The Author(s), under exclusive licence to Springer Nature Limited 2024.

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