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Impact of prior acute GVHD on chronic GVHD outcomes: a chronic graft versus host disease consortium study

Leukemia volume 27, pages 1196–1201 (2013)Cite this article

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Chronic graft-versus-host disease (CGVHD) is one of the most debilitating complications post hematopoietic cell transplant (HCT). Several studies have evaluated the factors affecting survival in CGVHD,1, 2, 3, 4, 5, 6, 7, 8 most utilizing the older definition of CGVHD, where patients with any symptoms of GVHD (acute or chronic) may be classified as CGVHD if found symptomatic beyond day 100 post HCT. However, the new National institutes of health (NIH) consensus guidelines have redefined the criteria for CGVHD diagnosis and staging9 based on the actual symptoms at presentation, and excludes the patients with persistent, recurrent or late acute graft-versus-host disease (AGVHD) who were previously considered to have CGVHD. The CGVHD consortium follows a large multi-center prospectively enrolled cohort of CGVHD patients utilizing NIH consensus guidelines for assessments.10 Several reports from this consortium have identified factors affecting survival, including global severity, thrombocytopenia, karnofsky performance score and overlap syndrome.11, 12

Prior AGVHD has been associated with a higher mortality in patients who develop CGVHD,1, 3 indicating that these patients may be more debilitated and hence suffer worse outcome. However, the clinical and prognostic importance of prior AGVHD on subsequent CGVHD in the current era, using NIH diagnostic and staging criteria, is unknown. We evaluated the significance of prior AGVHD on CGVHD presentation, overall response and survival in a contemporary cohort of CGVHD patients prospectively enrolled by the CGVHD consortium. Cases enrolled in the consortium could be incident (enrollment <3 months after diagnosis) or prevalent (enrollment ⩾3 months after diagnosis).10 Detailed CGVHD assessments were performed reflecting the recommendations of the NIH consensus conference,9, 13 and are published in the cohort study rationale and design summary.10 Prior AGVHD was considered to be present if maximum grade I−IV was reported. Comparisons were performed between two groups: Prior AGVHD and no prior AGVHD. Statistical comparisons between groups were made with the two-sample t-test for continuous variables, and χ2-test for categorical variables. Spearman correlation coefficient (ρ,) and simple κ-statistics were used to describe rank correlation and agreement between AGVHD and CGVHD overall severity scores, and skin, gastrointestinal (GI) and liver severity.

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Acknowledgements

This work was supported by National Institutes of Health/National Cancer Institute grant CA 118953 (PI: Lee, SJ).

Author Contributions

MA, JP, CSC, DAJ, SZP, JP, GV, MJ, KS and SJL contributed clinical data; XC and BK performed statistical analysis and drafted the manuscript; MA and SJL designed research and drafted the manuscript; and all authors contributed to analysis and interpretation of data and critical review of the manuscript.

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Authors and Affiliations

  1. Division of Hematology, Oncology and Transplant, University of Minnesota, Minneapolis, MN, USA

    M Arora

  2. Moffitt Cancer Center, Tampa, FL, USA

    J Pidala

  3. Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA

    C S Cutler

  4. Fred Hutchinson Cancer Research Center and University of Washington, Seattle, WA, USA

    X Chai, B Kurland & S J Lee

  5. Children's National Medical Center, Washington, DC, USA

    D A Jacobsohn

  6. Experimental Transplantation and Immunology Branch, National Cancer Institute, Center for Cancer Research, Bethesda, MD, USA

    S Z Pavletic

  7. Medical College of Wisconsin, Milwaukee, WI, USA

    J Palmer

  8. Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

    G Vogelsang

  9. Vanderbilt University, Nashville, TN, USA

    M Jagasia

  10. University of British Columbia, Vancouver, BC, Canada

    K Schultz

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  1. M Arora
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  10. M Jagasia
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  11. K Schultz
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  12. S J Lee
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Corresponding author

Correspondence to M Arora.

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The authors declare no conflict of interest.

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Supplementary Information accompanies the paper on the Leukemia website

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Arora, M., Pidala, J., Cutler, C. et al. Impact of prior acute GVHD on chronic GVHD outcomes: a chronic graft versus host disease consortium study. Leukemia 27, 1196–1201 (2013). https://doi.org/10.1038/leu.2012.292

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