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Decreasing rates of cGvHD in all patient populations post HSCT
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Prospective data captured at the Fred Hutchinson Cancer Center (FHCC) revealed a steady decrease in cGvHD requiring systemic immunosuppression per NIH Consensus Criteria since 2005.1 To evaluate this trend, Carpenter et al.1 evaluated the risk of cGvHD requiring systemic immunosuppression among patients at FHCC who underwent allo-HSCT between 2005 and 2019 and survived to Day 100 without relapse. Results from this prospective study were published in Blood Advances.1 Data from 3,066 patients were evaluated, including 502 pediatric patients. The median follow-up was 7 years, with a median age at HSCT of 49 years.1 |
| Key learnings |
| Each 5-year increment in HSCT date was associated with a ~27% reduction in cGvHD risk (p < 0.0001); 19% after adjusting for typically expected cause-associated factors. This decline was observed across adult, pediatric, and nonmalignant disease transplant recipients. |
| Demographic shifts and greater use of HSCT techniques associated with lower cGvHD rates (e.g., T-cell depletion, cord blood transplantation, PTCy use) played a role but did not fully explain the risk reduction. |
| Advances in aGvHD management (e.g., refined corticosteroid use, improved microbiome preservation, and CMV control strategies) may have indirectly contributed to cGvHD reduction. |
| These findings suggest that ongoing refinements in transplant techniques and post-HSCT management are improving patient outcomes. They also highlight the need for contemporary controls, rather than historical comparisons, in cGvHD prevention studies. |
Abbreviations: aGvHD, acute graft-versus-host disease; allo, allogenic; cGvHD, chronic graft-versus-host disease; CMV, cytomegalovirus; FHCC, Fred Hutchinson Cancer Center; HSCT, hematopoietic stem cell transplant; NIH, National Institutes of Health; PTCy, post-transplant cyclophosphamide.
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