A new study has identified patterns of graft-versus-host disease (GVHD) in patients who received allogeneic hematopoietic stem cell transplantation (HSCT) with alemtuzumab and reduced-intensity conditioning (RIC). The study’s results were reported in the British Journal of Haematology.

Researchers assessed the outcomes of alemtuzumab-based GHVD prophylaxis by conducting a single-center, retrospective analysis of medical records from 201 patients who had undergone RIC HSCT with alemtuzumab as a component of the conditioning method.

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At median follow-up of 24 months, cumulative incidence of classic acute GVHD was 34% for grades 2 to 4 and 13% for grades 3 and 4 only. Late acute GVHD had a cumulative incidence of 20% for grades 2 to 4 and 8% for grades 3 to 4. Cumulative incidence of classic chronic GVHD was 4%. Overlap of acute and chronic forms of GVHD had a cumulative incidence of 7%.

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Prior history of classic acute GVHD was found to be associated with the development of chronic GVHD (hazard ratio [HR], 10.91; 95% CI, 2.35-50.63; P =.0023). However, late-onset acute GVHD did not appear to predispose patients to a later presentation of chronic GVHD. 

The 2-year overall survival (OS) rate was 58%. Survival did not appear to be influenced by chronic GVHD or late-onset acute GVHD; however, classic acute GVHD, even including grades 2 to 4, was associated with increased mortality (HR, 1.64; 95% CI, 1.08-2.48; P =.0192). Grade 3 or 4 classic acute GVHD had a stronger influence on mortality (HR, 2.83; 95% CI, 1.71-4.78; P =.0001).

“The results of this retrospective study confirm that GVHD prophylaxis with alemtuzumab is an effective strategy to prevent GVHD in the setting of RIC HSCT,” wrote the researchers. They also concluded that it was possible to identify patterns of GVHD development and prognoses associated with specific GVHD subtypes using a multistate model.

Reference

  1. Finazzi MC, Boschini C, Craddock C, Rambaldi A, Ward J, Malladi RK. Characteristics of graft-versus-host disease occurring after alemtuzumab-containing allogeneic stem cell transplants: incidence, organ involvement, risk factors and survival [published online November 12, 2019]. Br J Haematol. doi:10.1111/bjh.16200

Topics:

Hematopoietic Stem Cell Transplantation