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Immunology

Significantly worse survival of patients with NIH-defined chronic graft-versus-host disease and thrombocytopenia or progressive onset type: results of a prospective study

Leukemia volume 26, pages 746–756 (2012)Cite this article

Abstract

Chronic graft-versus-host disease (GVHD) remains a serious complication after allogeneic hematopoietic stem cell transplantation (HCT). In 2005 the National Institutes of Health (NIH) established new criteria for chronic GVHD based on retrospective data and expert recommendations. We prospectively evaluated the incidence of NIH-defined chronic GVHD and its prognostic impact in 178 consecutive patients. The cumulative incidence of chronic GVHD at 3 years was 64, 48 and 16% for chronic classic GVHD and overlap syndrome. Prior acute GVHD and myeloablative conditioning were significantly associated with increased risk of chronic GVHD. Three-year survival (overall survival (OS)) for late-acute GVHD, chronic classic and overlap chronic GVHD when assigned on day 100 were 69, 83 and 73%. OS was significantly worse for patients with platelet counts below 100 g/l at onset of chronic GVHD (35% versus 86%, P<0.0001) and progressive as compared with de novo and quiescent onset of chronic GVHD (54.5% versus 89.5% versus 84%, P=0.022 and 0.001). Peak severity of chronic GVHD had no impact on non-relapse mortality (NRM) and OS. Recurrent acute GVHD, platelet counts below 100 g/l at diagnosis of chronic GVHD, progressive onset of chronic GVHD and advanced disease stage prior to HCT were significantly associated with increased NRM. This prospective analysis provides for the first-time data on the incidence rates of NIH-defined chronic GVHD categories and identified risk factors for the occurrence of chronic GVHD. A prognostic value of thrombocytopenia and progressive onset type of chronic GVHD for survival after HCT was observed in NIH-defined chronic GVHD.

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Acknowledgements

We thank Dr Peter Bauer from the Institute of Medical Statistics of the Medical University of Vienna for his assistance in statistical analyses. The study was supported by European Commission Grant 037703 STEMDIAGNOSTICS and a grant by Austrotransplant.

Author contributions

HTG designed the research study, analyzed and interpreted the data, and co-authored the manuscript; ZK performed the clinical research, collected and analyzed data; AB, SE, LV and PK performed clinical assessments of chronic GVHD according to the NIH criteria; VP, KK, GS, UJ and JN performed assessments of defined organ manifestations of chronic GVHD according to the NIH consensus criteria; EP performed the statistical analyses; RK and NW were involved in clinical assessments and therapy of patients.

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Authors and Affiliations

  1. Department of Internal Medicine I, Bone Marrow Transplantation, Medical University of Vienna, Vienna, Austria

    Z Kuzmina, S Eder, A Böhm, L Vormittag, P Kalhs & H T Greinix

  2. Department of Statistics, Medical University of Vienna, Vienna, Austria

    E Pernicka

  3. Department of Internal Medicine II, Division of Pulmonology, Medical University of Vienna, Vienna, Austria

    V Petkov & K Krenn

  4. Department of Dermatology, Division of Immunodermatology and Infectious Skin Diseases, Medical University of Vienna, Vienna, Austria

    G Stary

  5. Department of Dermatology, Division of General Dermatology, Medical University of Vienna, Vienna, Austria

    R Knobler & U Just

  6. Department of Ophthalmology, Medical University of Vienna, Vienna, Austria

    J Nepp

  7. Department of Blood Group Serology and Transfusion Medicine, Medical University of Vienna, Vienna, Austria

    N Worel

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  1. Z Kuzmina
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Correspondence to H T Greinix.

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Preliminary data of this manuscript were presented at the Annual Meeting of the European Group for Blood and Marrow Transplantation in March 2010 in Vienna, Austria.

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Kuzmina, Z., Eder, S., Böhm, A. et al. Significantly worse survival of patients with NIH-defined chronic graft-versus-host disease and thrombocytopenia or progressive onset type: results of a prospective study. Leukemia 26, 746–756 (2012). https://doi.org/10.1038/leu.2011.257

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