Improvements in Survival for Patients With Severe Acute or Severe Chronic GVHD

Historically, patients with severe (grade 3-4) acute graft-versus-host disease (GVHD) and severe chronic GVHD as determined by the National Institutes of Health (NIH) have poor survival. New research being presented at the 61st American Society of Hematology Annual Meeting & Exposition shows that earlier treatment with novel therapies can improve outcomes for these patients.

The researchers analyzed the impact of allografts on patients. They found that of 851 patients receiving allografts between January 2005 and December 2016, 130 patients (15.3%) developed severe acute GVHD. Of 522 patients who underwent allografts between April 2011, the start of prospective documentation of NIH grade chronic GVHD, and December 2016, 146 (28%) developed moderate to severe NIH grade chronic GVHD.

For the patients with severe acute GVHD, the survival rate was 62% at 1 year, 49% at 2 years, and 47% at 3 years. Patients who developed severe acute GVHD in 2016-2017 had a significantly improved survival rate over patients who developed it in 2005-2015: 1-year survival was 86% versus 55% and 2-year survival was 79% versus 41%.

There will no significant different in survival among patients who developed moderate chronic GVHD, but there were differences among the patients who developed severe chronic GVHD in 2011-2013, 2014-2015, and 2016-2017. The 1-year survival was 87% in 2016-2017 compared with 79% in 2014-2015, and 53% in 2011-2013. The 2-year survival was 74% in 2016-2017 compared with 73% in 2014-2015, and 41% in 2011-2013.

“These data suggest that survival of patients developing either severe [acute] GVHD or severe NIH grade [chronic] GVHD has significantly improved in recent years compared to historical controls,” the authors concluded. “More than two-thirds of such patients now survive two years from onset of severe GVHD. This must be taken into account when evaluating novel therapies for severe GVHD.”

References

Bashey A, Zhang X, Morris LE, Holland HK, Solh M, Solomon SR. Improved survival or patients diagnosed with severe (grade 3-4) acute GVHD or severe NIH grade chronic GVHD in the current era compared to historic controls. Presented at: 61st American Society of Hematology Annual Meeting & Exposition, December 7-10, 2019; Orlando, Florida. Abstract #2006.