Burden of hospitalizations and outpatient visits associated with moderate and severe acute graft-versus-host disease in Finland and Sweden: a real-world data study

Abstract

Purpose The aim of this study was to describe patient characteristics and quantify hospital stays and outpatient visits (H&OV) following diagnosis with moderate-to-severe acute graft-versus-host disease (aGVHD) in Finland and Sweden. Methods A retrospective chart audit collected data from patient medical records of 3 specialized centers performing allogeneic hematopoietic stem cell transplantation (HSCT; Finland, n = 2; Sweden, n = 1). Eligible patients received allogeneic HSCT (January 1, 2016–June 30, 2017) from any donor source, were diagnosed with grade II–IV aGVHD (MAGIC or modified Glucksberg criteria) at any time from transplantation to 12 months before data collection, and were ≥ 18 years old at diagnosis. Criteria for comparing patients graded with modified Glucksberg and MAGIC severity scales were defined. Results Fifty-five patients (Finland, n = 45; Sweden, n = 10) were included. Myeloablative conditioning was the most common conditioning regimen (81.8%); immunosuppression regimens were based on combinations of methotrexate (96.4%), in vivo T-cell depletion (80.0%), cyclosporine (63.6%), mycophenolate (40.0%), and tacrolimus (34.5%). Sixteen patients (29.1%) developed grade III/IV aGVHD; skin was the most common organ involved (80.0%). Most patients required ≥ 1 hospital stay (89.1%; median of 2 hospitalizations per patient); 7 patients (14.3%) required admission to an intensive care unit. Median hospitalization duration from HSCT to discharge was 26 days. Most patients also required outpatient or emergency department visits (90.9%). Subgroup analyses showed longer hospital stays for patients receiving multiple treatment lines; no clear differences in H&OV were observed between prophylactic regimens. Conclusion Based on this retrospective study, moderate-to-severe aGVHD is associated with considerable healthcare resource utilization in Finland and Sweden, particularly in patients who received multiple lines of therapy.

Treatment Patterns and Clinical Outcomes of Patients with Moderate to Severe Acute Graft-Versus-Host Disease: A Multicenter Chart Review Study

“…Our group has previously shown that moderate to severe aGVHD is associated with high rates of hospitalizations and outpatient visits among patients receiving allogeneic HSCT at transplant centers in Finland and Sweden [ 18 ]. Taken together, findings from this study and previous reports demonstrate the substantial burden of aGVHD among allogeneic HSCT recipients and highlight the need for more effective treatment strategies that can improve clinical outcomes.…”

“…The differences in staging and grading systems among sites (i.e., MAGIC vs. modified Glucksberg) may have affected the results, although an alignment process was performed to ensure compatibility across grading systems (Supplementary Figures S1–S3 ). The alignment process grouped and mapped modified Glucksberg cases into MAGIC (instead of doing the opposite, i.e., mapping or naively comparing patients graded in MAGIC with patients graded in Glucksberg) [ 18 ].…”

“…Grades II–IV aGVHD were defined as skin stage ≥ 3 and/or liver ≥ 1 and/or GI ≥ 1 per MAGIC and modified Glucksberg/Keystone criteria; grades B–D were defined as skin stage ≥ 2 and/or liver ≥ 1 and/or GI ≥ 1 per IBMTR criteria ( Supplementary Figure S1 ) [ 22 ]. Patients who were graded based on MAGIC criteria were compared with those graded on alternative scales by using mapping rules derived from grade and organ score definitions for each respective scale ( Supplementary Figures S2 and S3 ) [ 18 ].…”

“…The following supporting information can be downloaded at: https: //www.mdpi.com/article/10.3390/hematolrep16020028/s1, Figure S1: Comparison of (A) aGVHD Severity Grading and (B) Organ Staging Across Grading Scales; Figure S2: Mapping Rules for Comparing MAGIC Grading to Other Scales; Figure S3: Overview of aGVHD Grading Systems; Table S1: aGVHD Severity at Diagnosis Based on MAGIC and mGlucksberg Criteria. References [18][19][20][21][22] are cited in the Supplementary Materials.…”

“…In a prior analysis from the present study, that included only patients from Finland and Sweden with grades II–IV aGVHD, nearly 90% of patients required hospitalization, with a median length of stay of 26 days and over 10 outpatient or emergency department visits per year on average [ 18 ]. Patients who received multiple treatment lines had longer hospital stays than those who received only one line of treatment.…”