Risk and prognostic factors for acute GVHD based on NIH consensus criteria

Abstract

To investigate the risk factors for acute GVHD (aGVHD), based on NIH consensus criteria (NCC), we evaluated 775 patients who underwent allogeneic transplantation. Of them, 346 patients developed aGVHD by NCC, in whom we also analyzed factors affecting aGVHD-specific survival. The cumulative incidence of aGVHD was 44.7%, consisting of classic aGVHD (n ¼ 320) and late-onset (n ¼ 26). Multivariate analyses revealed that younger age (P ¼ 0.015), unrelated donors (P ¼ 0.004) and acute leukemia compared with other hematologic malignancies (P ¼ 0.005) were significant risk factors for aGVHD, whereas PBSCs showed no association (P ¼ 0.720). Multivariate analyses, with only aGVHD patients, revealed that late-onset aGVHD had superior aGVHD-specific survival to classic aGVHD (P ¼ 0.044), and identified the association of visceral organ involvement (P ¼ 0.002), severity of aGVHD at onset (P ¼ 0.035) and advanced disease status (Po0.001) with inferior aGVHD-specific survival. In conclusion, this study demonstrates the risk and prognostic factors for aGVHD by NCC with some differences with the previous reports that were based on old criteria. The difference in the risk factors according to different criteria will give insights about the pathophysiology of GVHD. The better prognosis of late-onset aGVHD than of classic aGVHD raises the necessity for prospective trials with a large cohort focusing on the onset time.

Late acute graft-versus-host disease: a prospective analysis of clinical outcomes and circulating angiogenic factors

“…Wide variation exists in prior estimates of incidence of LA GVHD. [2][3][4][18][19][20][21] Our data support an incidence of 11% at 2 years after HCT. De novo onset LA GVHD is more common in patients undergoing reduced intensity HCT.…”

“…Although reclassification following the NIH Consensus Conference improved diagnostic criteria, 1 subsequent retrospective analyses have not uniformly found that LA GVHD has a prognosis distinct from acute or chronic GVHD. [2][3][4][5][6][7] Improved understanding of LA GVHD is needed prior to development of There is an Inside Blood Commentary on this article in this issue.…”

Acute Graft Versus Host Disease: A Comprehensive Review

“…Anesseti et al showed that the incidence of aGVHD with the use of pBsc was about the same as in bone marrow (BM) however the incidence of cGVHD was increased by 16% as compared to bone marrow (26). The use of double unit umbilical cord transplant (dUcB) has been associated with lower incidence of cGVHD but higher incidence of aGVHD (27). other studies have reported no impact of stem cell source on aGVHD (28)(29)(30).…”

Extracorporeal photopheresis increases neutrophilic myeloid-derived suppressor cells in patients with GvHD

“…aGvHD and cGvHD were scored according to the NIH Consensus Conference and the Glucksberg criteria 23 as described previously in detail. [24][25][26] aGvHD was graded by staging the affected organs, particularly skin, liver and gut (stage 1-4) and subsequently determining an overall grade (grade I-IV). 2 Grading of cGvHD was performed by scoring the organ involvement (score 0-3) and global severity grading (mild, moderate, severe).…”