Prognostic factors identifiable at the time of onset of acute graft-versus-host disease after allogeneic hematopoietic cell transplantation

Hematology Section, Department of Internal Medicine, University of Ulsan, College of Medicine, Asan Medical Center, Seoul, Korea. khlee2@amc.seoul.kr

BACKGROUND AND OBJECTIVES: Current grading systems of acute graft-versus-host disease (GVHD) cannot effectively identify patients with poor prognosis at the onset of acute GVHD after allogeneic hematopoietic cell transplantation. DESIGN AND METHODS: In a retrospective analysis, we evaluated the prognostic value of various clinical parameters at the initiation of treatment in 83 patients who developed systemic treatment-requiring acute GVHD after allogeneic hematopoietic cell transplantation. RESULTS: Forty-three of 83 patients (52%) experienced initial treatment failure (40 required secondary treatment due to lack of response and 3 died) and 43 (52%) experienced treatment success, defined as completion of treatment (initial and, if given, secondary) within 100 days. The GVHD-specific survival rate was 65.5%, with 27 deaths due to GVHD-related complications without relapse of underlying malignancies within 1 year. HLA-mismatched transplantation, visceral initiation, and peripheral blood lymphocytopenia ( pound100/mL) were independent variables predicting higher initial treatment failure (Odd ratios (OR)=12.225, 12.036, and 7.481, respectively). The above variables and initial acute GVHD grade III-IV vs. II were independent variables predicting shorter GVHD-specific survival (OR=0.322, 0.247, 0.340, and 0.385, respectively). High-risk disease status, visceral initiation, and hypoalbuminemia ( pound2.8 g/dL) were independent variables predicting lower treatment success (OR=0.221, 0.162, and 0.270, respectively). The predictive value of visceral initiation and lymphocytopenia for GVHD-specific survival was verified in an independent cohort of 58 patients. INTERPRETATION AND CONCLUSIONS: Lymphocytopenia and hypoalbuminemia may be useful baseline prognostic factors for acute GVHD after allogeneic hematopoietic cell transplantation.