title: Late Acute and Chronic Graft-versus-Host Disease after Allogeneic Hematopoietic Cell Transplantation.
abstract: Several distinct graft-versus-host disease (GVHD)-related syndromes have been defined by the National Institutes of Health Consensus Conference. We enrolled a prospective cohort of 911 hematopoietic cell transplantation (HCT) recipients at 13 centers between March 2011 and May 2014 to evaluate 4 GVHD syndromes: late acute GVHD (aGVHD), chronic GVHD (cGVHD), bronchiolitis obliterans syndrome, and cutaneous sclerosis. The median age at HCT was 53.7 years. The majority of patients received a peripheral blood stem cell transplant (81%) following nonmyeloablative or reduced-intensity conditioning (55%). Pediatric age group and use of bone marrow and umbilical cord blood grafts were underrepresented in our cohort (≤11%). The cumulative incidence of late aGVHD (late onset and recurrent) was 10% at a median of 5.5 months post-HCT, that of cGVHD was 47% at a median of 7.4 months, that of bronchiolitis obliterans was 3% at a median of 12.2 months, and that of cutaneous sclerosis was 8% at a median onset of 14.0 months. Late aGVHD and bronchiolitis obliterans had particularly high nonrelapse mortality of 23% and 32%, respectively, by 2 years after diagnosis. The probability of late aGVHD- and cGVHD-free, relapse-free survival was 38% at 1 year post-HCT and 26% at 2 years post-HCT. This multicenter prospective study confirms the high rate of late aGVHD and cGVHD syndromes and supports the need for continuous close monitoring and development of more effective GVHD treatment strategies to improve HCT success.
authors.affiliation: Division of Hematology, Oncology and Transplant, University of Minnesota Medical School, Minneapolis, Minnesota. Electronic address: arora005@umn.edu.
authors.forename: Mukta
authors.initials: M
authors.lastname: Arora
authors.affiliation: Division of Hematologic Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.
authors.forename: Corey S
authors.initials: CS
authors.lastname: Cutler
authors.affiliation: Division of Hematology and Stem Cell Transplant, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Madan H
authors.initials: MH
authors.lastname: Jagasia
authors.affiliation: Blood and Marrow Transplantation Program, Moffitt Cancer Center, Tampa, Florida.
authors.forename: Joseph
authors.initials: J
authors.lastname: Pidala
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Xiaoyu
authors.initials: X
authors.lastname: Chai
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Paul J
authors.initials: PJ
authors.lastname: Martin
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.affiliation: Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Inamoto
authors.affiliation: BMT Program, Department of Medicine, Roswell Park Cancer Institute, Buffalo, New York.
authors.forename: George L
authors.initials: GL
authors.lastname: Chen
authors.affiliation: Division of Hematology and Oncology, University of North Carolina Hospitals, Chapel Hill, North Carolina.
authors.forename: William A
authors.initials: WA
authors.lastname: Wood
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Nandita
authors.initials: N
authors.lastname: Khera
authors.affiliation: Division of Hematology/Oncology, Mayo Clinic, Phoenix, Arizona.
authors.forename: Jeanne
authors.initials: J
authors.lastname: Palmer
authors.affiliation: Division of Hematology and Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, Ohio.
authors.forename: Hien
authors.initials: H
authors.lastname: Duong
authors.affiliation: Division of Blood and Marrow Transplantation, Stanford University Medical Center, Stanford, California.
authors.forename: Sally
authors.initials: S
authors.lastname: Arai
authors.affiliation: Division of Hematology and Medical Oncology, New York Presbyterian Hospital/Weill Cornell Medical College, New York, New York.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Mayer
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St Louis, Missouri.
authors.forename: Iskra
authors.initials: I
authors.lastname: Pusic
authors.affiliation: Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Stephanie J
authors.initials: SJ
authors.lastname: Lee
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D064591:Allografts; D001989:Bronchiolitis Obliterans / Q000209:etiology / Q000401:mortality; D002908:Chronic Disease; D036101:Cord Blood Stem Cell Transplantation; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015996:Survival Rate
keywords: Bronchiolitis obliterans syndrome; Chronic graft-versus-host disease; Cutaneous sclerosis; Graft-versus-host disease syndromes; Hematopoietic cell transplantation; Late acute graft-versus-host disease