424 Improved Survival of Patients (Pts) with Acute Graft-Versus-Host Disease (aGVHD) During Recent Years: Impact of Donor and Recipient Characteristics

Track: Contributed Abstracts
Saturday, February 16, 2013, 6:45 PM-7:45 PM
Hall 1 (Salt Palace Convention Center)
Jonathon B Cohen, MD , Division of Hematology, The Ohio State University, Columbus, OH
Ali McBride, PharmD, MS , Pharmacy, The Ohio State University Comprehensive Cancer Center, Columbus, OH
Susan Geyer, Ph.D. , Division of Biostatistics, The Ohio State University, Columbus, OH
Anissa Bingman, MS , Division of Biostatistics, The Ohio State University, Columbus, OH
Patrick Elder, MS , Division of Hematology, The Ohio State University, Columbus, OH
William Blum, MD , Division of Hematology, The Ohio State University, Columbus, OH
Rebecca Klisovic, MD , Division of Hematology, The Ohio State University, Columbus, OH
Sam Penza, MD , Division of Hematology, The Ohio State University, Columbus, OH
Leslie A Andritsos, MD , Division of Hematology, The Ohio State University, Columbus, OH
Don M Benson, MD, PhD , Division of Hematology, The Ohio State University, Columbus, OH
Yvonne Efebera, MD , Division of Hematology, The Ohio State University, Columbus, OH
Craig C Hofmeister, MD , Division of Hematology, The Ohio State University, Columbus, OH
Ramiro Garzon, MD , Division of Hematology, The Ohio State University, Columbus, OH
Guido Marcucci, MD , Division of Hematology, The Ohio State University, Columbus, OH
Steven M Devine, MD , Division of Hematology, The Ohio State University, Columbus, OH

Background:  Based on our clinical impression, pts with grade 3-4 aGVHD have had improved survival in recent years.  In order to explore this observed trend, we evaluated factors associated with outcome in these pts.

Methods: Pts who had an allogeneic stem cell transplant (SCT) and who were evaluable for aGVHD by Glucksberg criteria were included, with SCT segregated into the following time periods (pds): 1990-1994, 1995-1999, 2000-2004, and 2005-2011. Pts undergoing cord or haplo-identical SCT were excluded. We evaluated the impact of variables of interest and time pd of SCT on overall survival (OS), defined as time from SCT to death, using univariate and multivariate analyses.

Results: 959 pts were included (See Table), and 62.5% had peripheral blood (PB) grafts.  Of the 388 unrelated SCT's, 56% received anti-thymocyte globulin (ATG).  Thirty-seven percent of all pts had reduced-intensity conditioning, and 91% were complete HLA matches. Median recipient age was 47 years (range: 18 – 75), but age increased with time pd of SCT (See Table; p<0.0001).  Use of a male donor also increased with time (p<0.0001).  Grade 3-4 aGVHD incidence was 16.6% and significantly differed by time pd (See Table; p=0.028).   It occurred in 17.6% of pts receiving ATG, compared to 28.7% of those who did not receive ATG (p=0.005).  After including time pd and other donor- and graft-related covariates, only ATG administration was a significant predictor for decreased grade 3-4 aGVHD (p=0.026).  Use of PB graft approached significance (p=0.053).  568 pts have died, and median follow-up is  49 months (range: 3 to 253) in living pts. Median OS for pts with grade 3-4 aGVHD is 5.0 months, compared to 36.2 and 34.8 months for pts with grade 2 and grade 0-1 aGVHD, respectively (p<0.0001).  Among pts with grade 3-4 aGVHD, median OS is improved with more recent SCT (See Table; p=0.018).  Having a male donor (p=0.0018) and a PB graft (0.017) are also associated with improved OS in univariate analyses, while related vs. unrelated donor, complete HLA match, ATG use, and recipient age are not.  Multivariable analysis was challenging given the correlation among covariates.  However, male donor is significantly associated with improved OS for pts with grade 3-4 aGVHD in all models, while time pd is not significant when adjusting for other factors.

Conclusions: While OS for pts with grade 3-4 aGVHD has improved, it continues to impact >13% of pts and has poor outcomes.  The use of a male donor may predict improved OS for pts with grade 3-4 aGVHD independent of time pd.  Additional study is warranted to validate these findings and improve therapies.

Table.

 

1990-1994

1995-1999

2000-2004

2005-2011

All periods

# of Patients

122

173

207

457

959

Median Age

35

43

46

52

47

Percent male donors

57

52

57

72

63

Incidence Grade 3-4 GVHD (%)

18

23.1

17.4

13.3

16.6

Median OS, mo

19.6

25.5

11.0

37.9

22.3

Median OS, mo

(pts with Gr 3-4 GVHD)

3.7

5.7

3.5

8.8

5.0

 

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