engleski

Incidence of chronic Graft-versus-Host Disease – results from a prospective multicentre analysis of 2 cohorts

Background: Incidence of chronic Graft-versus- Host Disease (cGvHD) is ~45%, but varies significantly depending on conditioning regimen, choice of donor, stem cell source, age and GvHD prophylaxis. In the past, increasing cGvHD incidence was reported due to accumulation of risk factors, but recent studies capturing the effect of new prophylaxis strategies are lacking. Methods: This study was conducted as joint analysis of 308 patients from two cohorts – cohort 1 included patients (pts) transplanted 2017 at University Hospital Zagreb (Croatia), and St. Anna Children`s Hospital, Vienna (Austria), cohort 2 included consecutive pts documented in period from July 2015 to September 2018 within the German- Austrian-Swiss GvHD register. Results: Cohort 1 consisted of 98 (55% male), mainly adult pts (70%), who underwent allogeneic hematopoietic stem cell transplantation (alloHSCT) at median age of 40 (range 0-66) years, and cohort 2 out of 210 (65% male) pts transplanted at median age of 56 (range 19-70) years. Most frequent indications for alloHSCT in both cohorts were acute leukaemia (51.9%), myelodysplastic/myeloproliferative diseases (19.2%), lymphoma (15.6%), plasma cell disorders (5.5%), non-malignant diseases (7.2%), and solid tumours (0.7%). 65% of all alloHSCT were performed from unrelated donors, 23% from matched related donors and 12% from haploidentical donors (25% in cohort 1 vs. 6% in cohort 2). Peripheral blood stem cells were applied in 73%, while 27% received bone marrow grafts. For both cohorts, at median follow-up of 333 (range 0-1149) days, the overall survival (OS) was 71% and cumulative incidence (CI) of treatment related mortality (TRM) 19%. CI of malignant disease relapse was 21%, and occurred at median of 154 (range 0-757) days after alloHSCT. Acute GvHD was reported with CI of 42% (6% for stage III/IV) in period of 100 days. For cohort 1 late acute GvHD had CI of 10% (1% for stage III/IV) and occurred at median time of 166 (range 110-424) days after alloHSCT and for cohort 2 CI was 11% (3% for stage III/IV) and occurred at median time of 217 (range 106-562) days. In cohort 1 CI of cGvHD was 14% and all pts had NIH moderate/severe global score at onset which occurred at median of 197 (range 62-700) days with de novo, progressive and quiescent onset in 42%, 25% and 33%, respectively. In cohort 2 CI of cGvHD was 39% (19% moderate/severe) at onset at median of 197 (range 92-588) days with de novo, progressive and quiescent onset in 37%, 1% and 62%, respectively. Four pts of cohort 2 were diagnosed with cGvHD with other manifestations such as glomerulonephritis or cerebral vasculitis. Among cGvHD pts from cohort 1 most involved organs at onset were mouth (82%), skin (73%), and eyes (64%) followed by liver (55%), gastrointestinal tract and lung (each 27%) and genital tract (18%) with a median Karnofsky/Lansky score of 80% (range 50-100). In the joint analysis, 71% pts required second line treatment. Conclusions: This study shows for the first time a decreasing incidence of cGvHD compared to previous publications which may reflect the change in practice pattern in prophylaxis and treatment of GvHD

chronic Graft-versus-Host disease, incidence, multicentre analysis, hematopoietic stem cell transplantation

nije evidentirano