IC-06. Impact of lung involvement on overall survival in chronic GVHD patients
Vera A. Vasilyeva, Larisa A. Kuzmina, Mikhail Yu. Drokov, Mariya V. Dovydenko, Olga M. Koroleva, Olga S. Starikova, Darya S. Dubnyak, Anna A. Dmitrova, Natalya M. Nikiforova, Ekaterina D. Mikhaltsova, Natalya N. Popova, Zoya V. Konova, Mobil I. Akhmedov, Ulyana V. Maslikova, Elena N. Parovichnikova,
National Medical Research Center of Hematology, Moscow, Russia
Dr. Vera A.Vasilieva, phone: +7(916) 262 2316, e-mail: vasilievaVA4@mail.ru
Chronic graft-versus-host disease (cGVHD) is a frequent complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), which significantly reduces the overall survival and quality of life.
Evaluation of overall survival in patients with chronic GVHD-associated lungs involvement.
Materials and methods
We analyzed the data of 723 allo-HSCT performed in 617 patients (2 and more allo-HSCTs performed in 78 cases) from January 2019 to June 2021. Chronic GVHD was diagnosed in 212 patients with mild cGVHD in 43, moderate in 91, and severe in 76 cases. Chronic was GVHD defined as per criteria of National Institutes of Health (NIH) . Lung involvement was diagnosed in 55 patients (moderate in 16, and severe in 39 patients), 26 women and 29 men. The underlying diagnosis was AL in 41, MDS/MPD in 9, and LPD in 5 cases, accordingly. Transplantation from a related matched donor was performed in 16 (29.1%) patients, from an unrelated mismatched donor in 11 (20%) patients, from an unrelated matched donor in 25 (45.5%), and from a haploidentical donor in 3 (5.4%) patients. Isolated lung involvement was detected in 11 patients; in other case skin/gut/liver/mucosa involvement was also observed. All the patients received immunosuppressive therapy. Prednisolone as the first line therapy was used only in 43 (76.8%) patients, 15 of them received second-line therapy, and 12 three or more lines of immunosuppression. Another first-line immunosuppressive regimens consisted of cyclosporin A, mycophenolate mofetil, extracorporeal photopheresis and\or ruxolitinib and were used in 13 (23.2%) patients with initially severe (n=5) or moderate (n=8) cGVHD. Prednisolone was withdrawn in four patients with moderate cGVHD, in one patient due to infectious complications and aseptic necrosis of femoral heads, in three patients due to stabilization of cGVHD-associated pulmonary changes achieved on prior systemic steroids, inhalation therapy and adequate antimicrobial therapy. Nine patients received prednisolone as second-line treatment due to the lack of response to first-line therapy.
Nineteen patients with pulmonary cGVHD died; 8 of them died from cGVHD and associated infectious complications; 7, due to relapse of underlining disease, 2 from COVID-19, 1 patient developed a second tumor and died during its treatment, and 1 patient died of myocardial infarction. The overall survival of patients with cGVHD with and without lung involvement significantly differed is shown in Figure 1.
Figure 1. Overall survival of patients with and without lung involvement with cGVHD
1. Jagasia M.H., Greinix H.T., Arora M., et al. National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. The 2014 Diagnosis and Staging Working Group Report. Biol Blood Marrow Transplant. 2015;21(3):389-401.e1. doi: 10.1016/j.bbmt.2014.12.001.
Chronic graft-versus-host disease, lung involvement, overall survival.