Skip to main content

Advertisement

SpringerLink
Log in

Prognostic factors for survival of patients with newly diagnosed chronic GVHD according to NIH criteria

  • Original Article
  • Published:
Annals of Hematology Aims and scope Submit manuscript

Abstract

Chronic graft versus host disease (cGvHD) is the most common cause of late morbidity and mortality after allogeneic hematopoietic stem cell transplantation (HSCT). We retrospectively evaluated the impact of NIH classification on outcome of patients at our center. Primary endpoint was overall survival at 5 years. Two hundred one patients with cGVHD according to NIH were included. Platelets <100,000/μl on day of diagnosis of cGvHD (HR 2.97, 95 % CI 1.7–5.3, p < 0.001), female donor (HR 1.78, 95 % CI 1.0–3.2, p = 0.05), and reduced intensity conditioning (HR 1.95, 95 % CI 1.0–3.8, p = 0.05) impacted overall survival. Non-relapse mortality (NRM) was higher for patients with low vs. high platelets: 26 % (95 % CI 14–40) vs. 6 % (95 % CI 2–10), p < 0.001, and tended to be higher for female vs. male donor: 14 % (95 % CI 7–23) vs. 7 % (95 % CI 3–13), p = 0.08. Relapse tended to be higher for recipients of reduced intensity conditioning (RIC) vs. myeloablative conditioning (MAC): 33 % (95 % CI 23–43) vs. 20 % (95 % CI 10–31), p = 0.06. After excluding patients with myeloma and lymphoma, IgG serum levels at diagnosis of cGvHD of 122 patients were correlated with survival. IgG levels above normal were associated with worse 2-year overall survival (OS), p = 0.04, compared to normal or low IgG levels. Platelet count at diagnosis remains the most valid prognostic factor for survival of patients with cGvHD even in the era of NIH grading. High IgG level at diagnosis of cGVHD represents a potential negative prognostic parameter that deserves further investigation.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Socie G, Stone JV, Wingard JR et al (1999) Long-term survival and late deaths after allogeneic bone marrow transplantation. Late Effects Working Committee of the International Bone Marrow Transplant Registry. N Engl J Med 34(1):14–21

    Article  Google Scholar 

  2. Flowers ME, Parker PM, Johnston LJ et al (2002) Comparison of chronic graft-versus-host disease after transplantation of peripheral blood stem cells versus bone marrow in allogeneic recipients: long-term follow-up of a randomized trial. Blood 100:415–419

    Article  CAS  PubMed  Google Scholar 

  3. Akpek G, Lee SJ, Flowers ME et al (2003) Performance of a new clinical grading system for chronic graft versus-host disease: a multicenter study. Blood 102(3):802–809

    Article  CAS  PubMed  Google Scholar 

  4. Akpek G, Zahurak ML, Piantadosi S et al (2001) Development of a prognostic model for grading chronic graft-versus-host disease. Blood 97(5):1219–1226

    Article  CAS  PubMed  Google Scholar 

  5. Arora M, Burns LJ, Davies SM et al (2003) Chronic graft-versus-host disease: a prospective cohort study. Biol Blood Marrow Transplant 9(1):38–45

    Article  PubMed  Google Scholar 

  6. Pavletic SZ, Smith LM, Bishop MR, Lynch JC, Tarantolo SR, Vose JM et al (2005) Prognostic factors of chronic graft-versus-host disease after allogeneic blood stem-cell transplantation. Am J Hematol 78(4):265–274

    Article  PubMed  Google Scholar 

  7. Sullivan KM, Witherspoon RP, Storb R et al (1988) Prednisone and azathioprine compared with prednisone and placebo for treatment of chronic graft-v-host disease: prognostic influence of prolonged thrombocytopenia after allogeneic marrow transplantation. Blood 72(2):546–554

    CAS  PubMed  Google Scholar 

  8. Wingard JR, Piantadosi S, Vogelsang GB et al (1989) Predictors of death from chronic graft-versus-host disease after bone marrow transplantation. Blood 74(4):1428–1435

    CAS  PubMed  Google Scholar 

  9. Stewart BL, Storer B, Storek J et al (2004) Duration of immunosuppressive treatment for chronic graft versus-host disease. Blood 104(12):3501–3506

    Article  CAS  PubMed  Google Scholar 

  10. Martin PJ, Storer BE, Carpenter PA et al (2011) Comparison of short-term response and long-term outcomes after initial systemic treatment of chronic graft-versus-host disease. Biol Blood Marrow Transplant 17(1):124–132

    Article  PubMed Central  PubMed  Google Scholar 

  11. Arora M, Klein JP, Weisdorf DJ et al (2011) Chronic GVHD risk score: a Center for International Blood and Marrow Transplant Research analysis. Blood 117:6714–6720

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  12. Arora M, Pidala J, Cutler CS et al (2013) Impact of prior acute GVHD on chronic GVHD outcomes: a chronic graft versus host disease consortium study. Leukemia 27(5):1196–1201

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  13. Perez-Simon JA, Afram G, Martino R et al (2012) Evaluation of prognostic factors among patients with chronic graft-versus-host disease. Haematologica 97(8):1187–1195

    Article  PubMed Central  PubMed  Google Scholar 

  14. Arai S, Jagasia M, Storer B et al (2011) Global and organ-specific chronic graft-versus-host disease severity according to the 2005 NIH Consensus Criteria. Blood 118(15):4242–4249

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  15. Lee SJ, Klein JP, Barrett AJ, Ringden O, Antin JH, Cahn J-Y et al (2002) Severity of chronic graft-versus-host disease: association with treatment-related mortality and relapse. Blood 100(2):406–414

    Article  CAS  PubMed  Google Scholar 

  16. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, Thomas ED (1995) 1994 Consensus Conference on Acute GVHD Grading. Bone Marrow Transplant 15(6):825–828

    CAS  PubMed  Google Scholar 

  17. Shulman HM, Sullivan KM, Weiden PL et al (1980) Chronic graft-versus-host syndrome in man. A long-term clinico-pathologic study of 20 Seattle patients. Am J Med 69:204–217

    Article  CAS  PubMed  Google Scholar 

  18. Filipovich AH, Weisdorf D, Pavletic S et al (2005) National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant 11:945–956

    Article  PubMed  Google Scholar 

  19. Pidala J, Vogelsang G, Martin P et al (2012) Overlap subtype of chronic graft-versus-host disease is associated with an adverse prognosis, functional impairment, and inferior patient-reported outcomes: a Chronic Graft-versus-Host Disease Consortium study. Haematologica 97(3):451–458

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank the nurses of the BMT wards for taking care of our patients, the study nurses for their assistance, and the medical technicians and scientists for their work in the BMT laboratories.

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Department of Stem Cell Transplantation, University Medical Center Hamburg, Martinistr. 52, 20246, Hamburg, Germany

    Francis Ayuk, Ronja Veit, Tatjana Zabelina, Lara Bussmann, Maximilian Christopeit, Haefaa Alchalby, Christine Wolschke, Heinrich Lellek, Ulrike Bacher, Axel R. Zander & Nicolaus Kröger

Authors
  1. Francis Ayuk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronja Veit
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Tatjana Zabelina
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lara Bussmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maximilian Christopeit
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Haefaa Alchalby
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Christine Wolschke
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Heinrich Lellek
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ulrike Bacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Axel R. Zander
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Nicolaus Kröger
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Francis Ayuk.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Table S4

Univariate analysis for Overall Survival (DOCX 20 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Ayuk, F., Veit, R., Zabelina, T. et al. Prognostic factors for survival of patients with newly diagnosed chronic GVHD according to NIH criteria. Ann Hematol 94, 1727–1732 (2015). https://doi.org/10.1007/s00277-015-2452-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00277-015-2452-6

Keywords

Search

Navigation