In a new study, researchers found a trend possibly linking treatment with a beta-adrenergic receptor antagonist (beta-blocker) to a potential impact on graft vs host disease (GVHD) in patients receiving allogeneic hematopoietic stem cell transplantation (HCT). Study findings were reported in the journal Hematology/Oncology and Stem Cell Therapy.
Inflammation is involved in development of GVHD, as the researchers in their report, with corticosteroids having a role in initial treatment. Since beta-blockers can also exert anti-inflammatory effects related to sympathetic nervous system activity, the researchers had a goal of evaluating how use of this class of therapy may impact outcomes with HCT related to GVHD.
The study was a retrospective analysis involving adult patients with hematologic malignancies who received allogeneic HCT with reduced intensity conditioning at Froedtert Hospital and Medical College of Wisconsin in Milwaukee, Wisconsin, between January 2014 and January 2017. HCT utilized human leukocyte antigen-matched related or unrelated donors.
In this study, the researchers analyzed patient records, including data related to beta-blocker usage and HCT outcomes. The primary study objective involved a comparison of rates of acute GVHD of grades 2 to 4 and grades 3 to 4 and chronic GVHD according to status of beta-blocker use and with respect to type of beta-blocker used. The study also had multiple survival-related secondary objectives.
A total of 151 patients were evaluated who had hematologic malignancies and who received allogeneic HCT with reduced intensity conditioning. Of these patients, 31 were receiving beta-blocker therapy at the time of transplantation, and of the patients receiving beta-blockers, 71% were receiving a selective beta-blocker.
Acute GVHD rates did not appear associated with beta-blocker use. However, a nonsignificant trend was seen between beta-blocker use at the time of transplant and chronic GVHD incidence, with a cause-specific hazard ratio of 0.49 (95% CI, 0.23-1.03; P =.06). The use of a beta-blocker was not associated with worse survival or relapse outcomes.
The cumulative incidence of day-100 acute GVHD of grades 2 to 4 was 22.6% with a beta-blocker, and it was 20.0% without a beta-blocker (P =.539). For day-100 acute GVHD of grades 3 to 4, these rates were 3.2% with a beta-blocker and 8.3% without (P =.984). The 1-year cumulative incidence of chronic GVHD was 27.6% with a beta-blocker and 37% without beta-blocker (P =.171). With use of a nonselective beta-blocker, the 1-year cumulative incidence of chronic GVHD was 11.1%, compared with 36.5% in patients using a selective beta-blocker or no beta-blocker (P =.07).
The researchers indicated the study’s results may suggest a possible impact on chronic GVHD development with HCT in the setting of nonselective beta-blocker therapy. However, they noted that further research, including with a randomized controlled trial, should be undertaken to verify the study findings.
Patel A, Subramanian Guru Murthy G, Hamadani M, Szabo A, Knight JM. The impact of beta-blocker use at the time of hematopoietic cell transplantation on the development of acute and chronic graft-versus-host disease. Hematol Oncol Stem Cell Ther. Published online November 5, 2021. doi:10.1016/j.hemonc.2021.10.001