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Clinical characteristics of steroid-responsive but dependent chronic graft-versus-host disease: a multicenter retrospective analysis

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Abstract

Chronic graft-versus-host disease (cGVHD) is a long-term complication of allogeneic hematopoietic stem cell transplantation. The clinical importance of long-term corticosteroid dependency in steroid-responsive cGVHD is undetermined. We retrospectively reviewed the data of 120 consecutive patients who received systemic steroid therapy for cGVHD between January 2007 and December 2018 at three institutions. Among patients with steroid-responsive cGVHD, those who successfully tapered off corticosteroids within 1 year were defined as the early withdrawal group (EW-cGVHD) and others were defined as the dependent group (Dp-cGVHD). Twenty-six patients were classified as EW-cGVHD and 55 as Dp-cGVHD. The proportion of men was significantly higher and performance status was significantly better in EW-cGVHD. The 5-year overall survival and cGVHD recurrence-free survival rates were significantly higher in EW-cGVHD than Dp-cGVHD (96% vs. 68%, p = 0.017 and 84% vs. 41%, p = 0.002, respectively). While the relapse-free survival rate did not differ significantly (84% vs. 65%, p = 0.15), the proportion of patients requiring readmission, mainly due to cGVHD recurrence or infection, was significantly increased in Dp-cGVHD (38% vs. 84%, p < 0.001). In summary, steroid dependency in cGVHD for more than 1 year was significantly associated with poor transplant outcomes.

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Acknowledgements

The authors would like to thank the patients and the physicians, nurses, pharmacists, transplantation coordinator, and other co-medical staff for their care of the patients involved in the study, and Editage (www.editage.com) for English language editing.

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Authors and Affiliations

  1. Department of Hematology and Oncology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan

    Takashi Oyama, Kensuke Matsuda, Akira Honda, Hiroaki Maki, Yosuke Masamoto & Mineo Kurokawa

  2. Department of Cell Therapy and Transplantation Medicine, The University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan

    Mineo Kurokawa

  3. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22, Honkomagome, Bunkyo-Ku, Tokyo, 113-8677, Japan

    Daisuke Murakami, Takashi Toya & Noriko Doki

  4. Division of Hematology, Department of Medicine, Keio University School of Medicine, 35, Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan

    Masatoshi Sakurai & Keisuke Kataoka

Authors
  1. Takashi Oyama
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  2. Kensuke Matsuda
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  3. Akira Honda
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  4. Hiroaki Maki
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  5. Yosuke Masamoto
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  6. Daisuke Murakami
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  7. Takashi Toya
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  8. Masatoshi Sakurai
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  9. Keisuke Kataoka
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  10. Noriko Doki
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  11. Mineo Kurokawa
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Contributions

TO, KM, AH, HM, YM, and MK were involved in the study design and data interpretation. TO, KM, DM, TT, MS, KK, and ND were involved in the data collection and analysis. All authors critically revised the report, commented on drafts of the manuscript, and approved the final report.

Corresponding author

Correspondence to Mineo Kurokawa.

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Competing interests

TT and ND have received payment for lectures from Novartis Pharma K.K. KK has received research grants form Shionogi Pharma Co., Ltd., and payment for lectures from Astellas Pharma Inc., Novartis Pharma K.K., and Pfizer Inc. MK has received payment for lectures and research grants form from Astellas Pharma Inc. and Pfizer Inc., and research grants from Shionogi Pharma Co., Ltd. This is not related to the current study. The other authors declare no competing financial interests.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Oyama, T., Matsuda, K., Honda, A. et al. Clinical characteristics of steroid-responsive but dependent chronic graft-versus-host disease: a multicenter retrospective analysis. Int J Hematol 117, 260–268 (2023). https://doi.org/10.1007/s12185-022-03471-0

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  • DOI: https://doi.org/10.1007/s12185-022-03471-0

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