Akahoshi Y, Spyrou N, Hogan WJ, et al. Incidence, Clinical Presentation, Risk Factors, Outcomes, and Biomarkers in De Novo Late Acute GVHD. Blood Advances. 2023; (doi: 10.1182/bloodadvances.2023009885).
Long-term survival outcomes among patients with de novo late acute graft-versus-host disease (GVHD) are comparable to those of patients with classic acute GVHD, new research suggests. The study included 3,542 consecutive adult hematopoietic cell transplant (HCT) recipients at 24 Mount Sinai Acute GVHD International Consortium (MAGIC) facilities between January 2014 and August 2021. Overall, 35.2% of the classic acute GVHD patients required systemic therapy, while another 5.7% of the patients were treated for late acute GVHD. The severity of late acute GVHD exceeded that of classic acute GVHD by both clinical and MAGIC Algorithm Probability biomarker parameters at symptom onset, yielding a lower overall response rate at day 28. Patients with classic and late acute GVHD did not differ in long-term non-relapse mortality and overall survival. Factors associated with late acute GVHD were advanced age, female to male sex mismatch, and the use of reduced intensity conditioning. Shifts in GVHD timing gave post-HCT cyclophosphamide-based GVHD prevention a protective effect. Although not definitive, the findings indicate that similar treatment plans are appropriate, based on clinical presentation at symptom onset.