Patients with persistent chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) appear to have less active inflammatory processes and increased symptom burden compared with patients with recently diagnosed cGVHD, according to findings published in the American Journal of Hematology.
Researchers conducted a prospective, cross-sectional natural history study of cGVHD. To do so, they assessed the clinical and biological factors of patients who presented with persistent cGVHD (lasting ≥ 7 years; 38 patients) and those with recently diagnosed (< 1 year) early cGVHD (83 patients).
Among patients with persistent cGVHD, median time since cGVHD diagnosis was 10.2 years (range, 7-27). More patients in the early cGVHD group were receiving systemic immunosuppression compared with the persistent cGVHD group (88% vs 58%).
To identify factors associated with persistent cGVHD, the team conducted a multivariable analysis and found that bone marrow stem cell source (P =.006), presence of extractable nuclear antigen autoantibodies (P =.003), higher National Institutes of Health lung score (P =.005), higher platelet counts (P =.006), and higher immunoglobulin A levels (P <.001) were significantly associated with persistent cGVHD.
From a panel of serum biomarkers, including 7 cytokines diagnostic for cGVHD, patients with persistent cGVHD had significantly lower levels of BAFF (P =.0002) and CXCL10 (P =.002) compared with the early cGVHD group. Additional biomarkers trended toward lower levels in the cGVHD group (CXCL9, P =.01; interferon gamma, P =.03; MCP-1, P =.01; and interleukin 6, P =.04) but were not statistically significant.
When patients of both groups were grouped according to established consensus GVHD categorizations for active, controlled, and inactive disease, only CXCL10 levels were higher in the active group (16 patients; median, 312.6) compared with the controlled (5 patients; median, 144.5) and inactive (2 patients; median, 167.6) groups (P =.04 for overall comparison).
“Standard accepted clinical measures of disease severity may not be helpful in distinguishing active disease from accumulated late effects in target organs and tissues,” the researchers wrote. They added, “Many patients with persistent cGVHD are still receiving systemic immunosuppression despite lacking evidence of disease activity.”
1. Goklemez S, Im AP, Cao L, et al. Clinical characteristics and cytokine biomarkers in patients with chronic graft‐vs‐host disease persisting seven or more years after diagnosis [published online January 5, 2020]. Am J Hematol. doi:10.1002/ajh.25717