EBMT 2018 | Chronic and late acute graft-versus-host disease defined by the 2005 NIH criteria – a prospective validation of a Japanese cohort

On Wednesday 21 March 2018, an oral abstract session was held at the 44^th Annual Meeting of the European Society for Blood and Marrow Transplantation (EBMT). The fourth talk in this session was given by Chikako Ohwada from Chiba University, Department of Hematology, Chiba, Japan, and was entitled “A multicenter observational study of chronic and late acute graft-versus-host disease defined by 2005 NIH criteria: a prospective validation of Japanese cohort”. This article is based on data presented at the live session, which may supersede information in the pre-published ASH abstract.

Doctor Ohwada reported results of a prospective validation study of the 2005 NIH consensus GvHD criteria in Asian population. In total, 406 patients (median age at HCT = 50 years) were enrolled who underwent allo-HCT between May 2012 to June 2014 in 16 centers of the Kanto Study Group for Cell Therapy.

Patient characteristics:

• Graft sources:
  • bone marrow 238 (58.6%)
  • cord blood 96 (23.7%)
  • peripheral blood (PB) 72 (17.7%)
• Stem cell donors were:
  • unrelated = 295 (72.7%)
  • related = 111 (27.3%)

Key findings:

• 2-year CI of cGvHD = 35.4%
• 2-year CI of late aGvHD = 3.5%
• 2-year CI of cGvHD in recipients of PB was higher: 43.1%
• The most common affected site was:
  • skin (51.7%)
  • mouth (45.5%)
  • liver (44.1%)
  • lung (34.5%)
  • eyes (26.9%)
  • GI (15.9%)
  • joints (6.2%)
• 2-year overall complete response (CR) rate = 31.9%
• 2-year partial response (PR) rate = 40.7%
• 2-year CI of systemic immunosuppressive therapy (IST) discontinuation = 30.3%, respectively
  • aGVHD (HR = 0.42, 95% CI, 0.23–0.76, P = 0.004) and severe global scoring (HR = 0.37, 95% CI, 0.16–0.90, P = 0.02) were negative predictive factors for discontinuation of IST
• 2-year overall survival (OS) = 81.3%
• GvHD specific survival (GSS) rate = 88.1%, respectively
• CI of disease relapse and non-relapse mortality (NRM) = 12.2% and 13.1%, respectively
• Prior aGVHD (HR = 2.79, 95% CI, 1.28–5.89, P = 0.01), skin score higher than 2 at the time of onset (HR = 2.93, 95% CI, 1.45–5.93, P = 0.003), and thrombocytopenia at the time of onset (HR = 3.47, 95% CI, 1.6–7.85, P = 0.001) were associated with inferior OS

The speaker concluded that these findings provided a complete profile of late acute and chronic GvHD for the first time in a Japanese prospective cohort including organ involvement and treatment outcomes. “The incidence of late acute and chronic GVHD in our study was lower than that reported from prospective observation in a North-American cohort (Arora et al. Biol Blood Marrow Transplant, 2016). This discrepancy outlines different characteristics between the cohorts, probably reflecting both graft sources and genetic backgrounds.”