Response to Immunosuppressive Treatment Predicts Outcome in Patients with Chronic Graft-versus-Host Disease: A Single-Center Analysis of Longitudinal Data

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Abstract

It has been reported that chronic graft-versus-host disease (cGVHD) is associated with significant morbidity and mortality after allogeneic stem cell transplantation (allo-SCT). The risk of relapse is generally reduced when cGVHD is present, but prognosis may be affected by increased toxicity and/or risk of infection associated with immunosuppressive treatment (IST). We performed a longitudinal data analysis of cGVHD, including the evolution of cGVHD itself over time in response to IST, in a single-center cohort of 313 consecutive patients undergoing allo-SCT. We found that lack of sustained response without withdrawal of IST within 6 months of cGVHD development was associated with higher transplantation-related mortality (hazard ratio, 2.32; 95% confidence interval, 1.24-4.33) compared with cGVHD-free patients. Conversely, response conferred better overall survival (hazard ratio, 0.42; 95% confidence interval, 0.18-0.95). Our analytical approach allowed us to integrate the evolution of cGVHD in a predictive model of transplantation outcome; notably, remission associated with permanent discontinuation of IST within the first 6 months from the occurrence of cGVHD seemed to correlate most closely with final outcome. Further confirmation from larger studies is needed. © 2013 American Society for Blood and Marrow Transplantation.

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Crocchiolo, R., Saillard, C., Signori, A., Fürst, S., El Cheikh, J., Castagna, L., … Blaise, D. (2013). Response to Immunosuppressive Treatment Predicts Outcome in Patients with Chronic Graft-versus-Host Disease: A Single-Center Analysis of Longitudinal Data. Biology of Blood and Marrow Transplantation, 19(4), 576–583. https://doi.org/10.1016/j.bbmt.2012.12.016

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