Multicenter non-interventional retrospective study: prevalence, clinical characteristics and approaches to the treatment of acute and chronic graft-versus-host disease in the Russian Federation

Abstract

Prevalence and management of acute and chronic graftversus-host disease (GvHD) after allogeneic hematopoietic cell transplantation (allo-HCT) vary widely depending on standard practices adopted in individual centers and countries. For Russian Federation, neither large study data on the incidence of GvHD in allo-HCT recipients, nor the range of approaches for prevention and treatment of this complication have been previously published. This study concerned the prevalence of this complication and the main appropriate clinical practices. Materials and methodsThe retrospective multicenter study involved four Russian allo-HCT centers, which provided information on all transplanted patients aged ≥12 years from January 1, 2020 to June 30, 2022 as well as detailed information on patients with acute and chronic GvHD. The study included 756 patients, among whom 240 had acute GvHD, 197 had chronic GvHD. An electronic platform was used to collect data, and the quality of the entered data was monitored. Since organ staging data was available, all severity grades were adjusted to the MAGIC criteria for acute GvHD and the NIH 2015 criteria for chronic GvHD results. ResultsThe incidence of acute GvHD grades I-IV was 31.7% of all allo-HCT recipients, grade I -13.0%, grade II -10.1%, grade III -5.2%, grade IV -3.4% of the total number of transplanted patients. The incidence of steroid-refractory acute GvHD was 33.8% of all patients with grades II-IV GvHD. The incidence of chronic GvHD was 26.1%, mild -6.5%, moderate -9.0%, severe -10.6% of all allo-HCT recipients. The most common organs involved in chronic GvHD were skin (69.0%), mucous membranes (60.4%), eyes (43.1%), liver (35.0%), genitals (11.7%) and gastrointestinal tract (11.2%). Lung GvHD (9.1%) and joint GvHD (3.6%), as well as the scleroderma (4.1%), were observed in a small number of patients. Steroid-refractory course was observed in 38.7% of patients receiving systemic therapy. Overlap syndrome was observed in 2.9% of all transplanted patients.