Success of Immunosuppressive Treatments in Patients with Chronic Graft-versus-Host Disease

• Published in: Biology of blood and marrow transplantation Vol. 24; no. 3; pp. 555 - 562
• Main Authors: Lee, Stephanie J., Nguyen, Tam D., Onstad, Lynn, Bar, Merav, Krakow, Elizabeth F., Salit, Rachel B., Carpenter, Paul A., Rodrigues, Morgani, Hall, A. Marcie, Storer, Barry E., Martin, Paul J., Flowers, Mary E.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2018
• Subjects: Allogeneic hematopoietic cell transplantation; Chronic graft-versus-host disease; Immunosuppressive treatment; Chronic graft-versus-host disease; Allogeneic hematopoietic cell transplantation; Immunosuppressive treatment
• DOI: 10.1016/j.bbmt.2017.10.042
• ISSN: 1083-8791

•After stopping therapy for chronic GVHD, half restarted after a median of 3.4 months.•After 5.6 years, one-third each were still on IST, alive off IST, or dead/relapsed. Moderate to severe chronic graft-versus-host disease (GVHD) is treated with potent immunosuppressive therapy (IST) to modulate the allo-immune response, control symptoms, and prevent further organ damage. We sought to understand the types of treatments used in clinical practice and the likelihood of successful treatment associated with each. A chart review was performed for 250 adult patients at Fred Hutchinson Cancer Research Center enrolled in a prospective observational study. After a median follow-up of 5.6 years for survivors, approximately one-third were still on IST (of whom half were on fourth or greater line of therapy), one-third were alive and off IST, and one-third had relapsed or died. Approximately half of survivors stopped all IST at least once, although half of these restarted IST after a median of 3.4 months (interquartile range, 2.3 to 8.0) off therapy. Successful discontinuation of IST for at least 9 months was associated with myeloablative conditioning (P = .04), more years since transplant (P = .009), and lack of oral (P < .001) and skin (P = .049) involvement compared with those who had to restart IST. We conclude that patients with chronic GVHD usually receive multiple lines and years of IST, with only a third off IST, alive, and free of malignancy at 5 years after chronic GVHD diagnosis. Patients stopping IST should be cautioned to self-monitor and continue close medical follow-up, especially for 3 to 6 months after stopping IST.