Nearly a Third of Patients with Chronic GVHD Able to Stop Long-Term Systemic Therapy

Nearly a third of patients with chronic graft-versus-host disease (GVHD) were able to discontinue long-term systemic therapy after 10 years, according to a recent study.

The results of the study, led by George Chen, MD, of the Roswell Park Comprehensive Cancer Center, were published in Haematologica.

The study evaluated the factors associated with durable long-term systemic therapy discontinuation, which was defined as cessation of all systemic therapy for at least a year.

Investigators used data from two prospectively followed cohorts (n=684) from the Chronic GVHD Consortium. Patients received transplants from peripheral blood (89%), bone marrow (6.6%), and cord blood (4.4%) that came from related donors who were human leukocyte antigen (HLA)-matched (37.6%), HLA-matched unrelated donors (45%), or other donor types (18%). Half of the patients received non-myeloablative conditioning.

The median time from transplantation to chronic GVHD diagnosis was 7.7 months (range, 1-141.3 months). The median time between chronic GVHD onset and cohort enrollment was 0.9 months (range, 0-12 months).

The cumulative incidence estimate of durable long-term systemic therapy discontinuation was 32% (95% CI, 28-37) 10 years after patients enrolled in the cohorts. The median time between chronic GVHD diagnosis and durable long-term systemic therapy discontinuation was 3.6 years (range, 1.2-10.5 years).

A multivariate analysis showed patients who received myeloablative conditioning and had chronic GVHD that manifested as moderate/severe lower gastrointestinal involvement plus a worse Lee symptom overall score were less likely to attain durable long-term systemic therapy discontinuation.

Mild lower gastrointestinal involvement and the use of cord blood instead of peripheral blood as a graft source were associated with a greater likelihood of durable long-term systemic therapy discontinuation.

“Although a minority of patients can discontinue systemic treatment permanently, most patients require prolonged systemic treatment,” the authors concluded. “Viewing chronic GVHD in this way has implications for management approaches.”

Chen GL, Onstad L, Martin PJ, et al. Durable discontinuation of systemic therapy in patients affected by chronic graft versus host disease. Haematologica. 2022. doi:10.3324/haematol.2021.279814