Acute GVHD classification based on the dynamics of GVHD skin involvement from its appearance to the start of systemic treatment

We conducted a prospective study aimed at investigating the prognostic value of the dynamic of a-GVHD progression from cutaneous to visceral involvement. In 108 consecutive patients who underwent allogeneic HSCT, we classified a-GVHD according to a "GHVD skin dynamic": 18/82 patients start...

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Published in:Bone marrow transplantation (Basingstoke) 2024-01, Vol.59 (1), p.17-22
Main Authors: Milone, Giuseppe, Leotta, Salvatore, Giuffrida, Giulia, Milone, Giulio Antonio, Sapuppo, Gabriele, Giunta, Giuliana, Esposito, Benedetta, Leotta, Dario, Fiore, Sebastiano, Pennisi, Chiara, Longo, Linda, Cupri, Alessandra
Format: Article
Language:English
Subjects:
Adrenal Cortex Hormones - therapeutic use
Graft vs Host Disease - drug therapy
Graft-versus-host reaction
Hematopoietic Stem Cell Transplantation - adverse effects
Humans
Multivariate analysis
Prognosis
Prospective Studies
Retrospective Studies
Risk
Skin
Stem cell transplantation
Subgroups
Surface area
Transplantation, Homologous
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Summary:We conducted a prospective study aimed at investigating the prognostic value of the dynamic of a-GVHD progression from cutaneous to visceral involvement. In 108 consecutive patients who underwent allogeneic HSCT, we classified a-GVHD according to a "GHVD skin dynamic": 18/82 patients started Corticosteroid (CS) within 48 h (Group 1); 13/82 started CS within days 3-7 (Group 2); Group 3A (n 31) was defined when Skin GVHD Overall Grade 1, left untreated for 1 week, showed an increase in involved body surface area 5%. These four groups had distinctive 2-y OS. Patients could be then grouped into "poor risk" (Group 1 and Group 3B) and "good risk" (Group 2 and Group 3A). "Poor risk" had inferior OS in univariate and multivariate analysis, (HR 2.222; 95% CL: 1.017-4.855; p 0.04). Among the patients with skin-only Grade 1 GVHD, subgroup 3A had an OS of 75.1% versus 39.8% found in subgroup 3B (p = 0.03). The dynamic of skin GVHD may be used to classify a-GVHD and guide treatment in Overall Grade 1 skin-only GVHD.
ISSN:0268-3369
1476-5365
DOI:10.1038/s41409-023-02107-z