Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Division of Emerging Medicine for Integrated Therapeutics, Center for Molecular Medicine, Jichi Medical University Shimotsuke, Japan.
Blood Adv. 2024 Aug 27;8(16):4250-4261. doi: 10.1182/bloodadvances.2024013442.
Chronic graft-versus-host disease (GVHD) is 1 of the major complications after allogeneic hematopoietic cell transplantation (allo-HCT). Although various risk factors for chronic GVHD have been reported, limited data are available regarding the impact of acute GVHD on chronic GVHD. We examined the association between acute and chronic GVHD using a Japanese registry data set. The landmark point was set at day 100 after allo-HCT, and patients who died or relapsed before the landmark point were excluded. In total, 14 618 and 6135 patients who underwent allo-HCT with bone marrow or peripheral blood (BM/PB) and with umbilical cord blood (UCB), respectively, were analyzed. In the BM/PB cohort, the risk for chronic GVHD that requires systemic steroids increased with each increase in acute GVHD grade from 0 to 2 (grade 0 vs 1 [hazard ratio (HR), 1.32; 95% confidence interval (CI), 1.19-1.46; P < .001]; grade 1 vs 2 [HR, 1.41; 95% CI, 1.28-1.56; P < .001]), but the risk was similar between acute GVHD grade 2 and grade 3 to 4 (HR, 1.02; 95% CI, 0.91-1.15; P = 1.0). These findings were confirmed in the UCB cohort. We further observed that the risk for severe chronic GVHD increased with each increment in the grade of acute GVHD, even between acute GVHD grade 2 and grade 3 to (grade 2 vs 3-4: HR, 1.70; 95% CI, 1.12-2.58; P = .025). In conclusion, the preceding profiles of acute GVHD should help to stratify the risk for chronic GVHD and its severity, which might be useful for the development of risk-adopted preemptive strategies for chronic GVHD.
慢性移植物抗宿主病（GVHD）是异基因造血细胞移植（allo-HCT）后的主要并发症之一。尽管已经报道了慢性 GVHD 的各种危险因素，但关于急性 GVHD 对慢性 GVHD 的影响的数据有限。我们使用日本注册数据集检查了急性和慢性 GVHD 之间的关联。里程碑时间设定为 allo-HCT 后第 100 天，排除在里程碑时间点之前死亡或复发的患者。总共分析了 14618 名和 6135 名接受骨髓或外周血（BM/PB）和脐带血（UCB）allo-HCT 的患者。在 BM/PB 队列中，随着急性 GVHD 分级从 0 到 2 的增加，需要系统类固醇治疗的慢性 GVHD 风险增加（分级 0 与 1[危险比（HR），1.32；95%置信区间（CI），1.19-1.46；P<0.001]；分级 1 与 2[HR，1.41；95%CI，1.28-1.56；P<0.001]），但急性 GVHD 分级 2 与 3-4 之间的风险相似（HR，1.02；95%CI，0.91-1.15；P=1.0）。这些发现在 UCB 队列中得到了证实。我们进一步观察到，随着急性 GVHD 分级的增加，严重慢性 GVHD 的风险增加，即使在急性 GVHD 分级 2 与 3-4 之间（分级 2 与 3-4：HR，1.70；95%CI，1.12-2.58；P=0.025）。总之，急性 GVHD 的先前表现有助于分层慢性 GVHD 及其严重程度的风险，这可能有助于制定针对慢性 GVHD 的风险适应性预防策略。
