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

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”.

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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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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