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Acute GVHD classification based on the dynamics of GVHD skin involvement from its appearance to the start of systemic treatment

Bone Marrow Transplantation volume 59, pages 17–22 (2024)Cite this article

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Abstract

We conducted a prospective study aimed at investigating the prognostic value of the dynamic of a-GVHD progression from cutaneous to visceral involvement. In 108 consecutive patients who underwent allogeneic HSCT, we classified a-GVHD according to a “GHVD skin dynamic”: 18/82 patients started Corticosteroid (CS) within 48 h (Group 1); 13/82 started CS within days 3–7 (Group 2); Group 3A (n 31) was defined when Skin GVHD Overall Grade 1, left untreated for 1 week, showed an increase in involved body surface area <5 %; Group 3B (n 20), was defined when Skin GVHD Overall Grade 1, left untreated at 1 week, had an increase in involved body surface area >5%. These four groups had distinctive 2-y OS. Patients could be then grouped into “poor risk” (Group 1 and Group 3B) and “good risk” (Group 2 and Group 3A). “Poor risk” had inferior OS in univariate and multivariate analysis, (HR 2.222; 95% CL: 1.017–4.855; p 0.04). Among the patients with skin-only Grade 1 GVHD, subgroup 3A had an OS of 75.1% versus 39.8% found in subgroup 3B (p = 0.03). The dynamic of skin GVHD may be used to classify a-GVHD and guide treatment in Overall Grade 1 skin-only GVHD.

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Fig. 1: Flowchart of the transplanted patients.
Fig. 2: OS and TRM in patients classified according to Consensus Classification and according to Skin acute GVHD dynamic.
Fig. 3: OS and TRM in patients classified as “poor risk” and “good risk”.

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Data availability

materials described in the manuscript, including all relevant raw data, are freely available to any researcher wishing to use them for non-commercial purposes, without breaching participant confidentiality. The datasets generated during and/or analysed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgements

We are grateful to dr Richard Brown for revising the English version of the manuscript.

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Authors and Affiliations

  1. Division of Hematology and Program of HSC Transplantation - Policlinico di Catania, 95124, Catania, Italy

    Giuseppe Milone, Salvatore Leotta, Giulia Giuffrida, Giulio Antonio Milone, Gabriele Sapuppo, Giuliana Giunta, Benedetta Esposito, Dario Leotta, Sebastiano Fiore, Chiara Pennisi, Linda Longo & Alessandra Cupri

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  1. Giuseppe Milone
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Contributions

AC: wrote the paper; SL: planned the study; GAM: collected data and treated the patients; GG: collected data and treated the patients; GS: collected data and treated the patients; BE: collected data and treated the patients; DL: collected data and treated the patients; CP collected data and treated the patients; SF: collected data and treated the patients; LL: collected data and treated the patients. GiuliaG: verified overall plan and data analysis; GM: planned the study and analysed the data.

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Correspondence to Giuseppe Milone.

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Milone, G., Leotta, S., Giuffrida, G. et al. Acute GVHD classification based on the dynamics of GVHD skin involvement from its appearance to the start of systemic treatment. Bone Marrow Transplant 59, 17–22 (2024). https://doi.org/10.1038/s41409-023-02107-z

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