Akahoshi, Yu and Spyrou, Nikolaos and Hoepting, Matthias and Aguayo-Hiraldo, Paibel and Ayuk, Francis and Chanswangphuwana, Chantiya and Choe, Hannah K. and Eder, Matthias and Etra, Aaron M. and Grupp, Stephan A. and Hexner, Elizabeth O. and Hogan, William J. and Kitko, Carrie L. and Kraus, Sabrina and Al Malki, Monzr M. and Merli, Pietro and Qayed, Muna and Reshef, Ran and Schechter, Tal and Ullrich, Evelyn and Vasova, Ingrid and Woelfl, Matthias and Zeiser, Robert and Baez, Janna and Beheshti, Rahnuma and Eng, Gilbert and Gleich, Sigrun and Kasikis, Stelios and Katsivelos, Nikolaos and Kowalyk, Steven and Morales, George and Young, Rachel and DeFilipp, Zachariah and Ferrara, James L. M. and Levine, John E. and Nakamura, Ryotaro (2024) Flares of acute graft-versus-host disease: a Mount Sinai Acute GVHD International Consortium analysis. BLOOD ADVANCES, 8 (8). pp. 2047-2057. ISSN 2473-9529, 2473-9537
Full text not available from this repository. (Request a copy)Abstract
The absence of a standardized definition for graft-versus-host disease (GVHD) flares and data on its clinical course are significant concerns. We retrospectively evaluated 968 patients across 23 Mount Sinai Acute GVHD International Consortium (MAGIC) transplant centers who achieved complete response (CR) or very good partial response (VGPR) within 4 weeks of treatment. The cumulative incidence of flares within 6 months was 22%, and flares were associated with a higher risk of nonrelapse mortality (NRM; adjusted hazard ratio [aHR], 4.84; 95% confidence interval [CI], 3.19-7.36; P < .001). Flares were more severe (grades 3/4, 41% vs 16%; P < .001) and had more frequent lower gastrointestinal (LGI) involvement (55% vs 32%; P < .001) than the initial GVHD. At CR/VGPR, elevated MAGIC biomarkers predicted the future occurrence of a flare, along with its severity and LGI involvement. In multivariate analyses, higher Ann Arbor (AA) biomarker scores at CR/VGPR were significant risk factors for flares (AA2 vs AA1: aHR, 1.81 [95% CI, 1.32-2.48; P = .001]; AA3 vs AA1: aHR, 3.14 [95% CI, 1.98-4.98; P < .001]), as were early response to initial treatment (aHR, 1.84; 95% CI, 1.21-2.80; P = .004) and HLA-mismatched unrelated donor (aHR, 1.74; 95% CI, 1.00-3.02; P = .049). MAGIC biomarkers also stratified the risk of NRM both at CR/VGPR and at the time of flare. We conclude that GVHD flares are common and carry a significant mortality risk. The occurrence of future flares can be predicted by serum biomarkers that may serve to guide adjustment and discontinuation of immunosuppression.
| Item Type: | Article |
|---|---|
| Uncontrolled Keywords: | MULTICENTER TRIAL; INITIAL TREATMENT; DOSE PREDNISONE; RISK; THERAPY; BIOMARKERS; DIAGNOSIS; ACCURACY; SURVIVAL; BLOOD; |
| Subjects: | 600 Technology > 610 Medical sciences Medicine |
| Divisions: | Medicine > Lehrstuhl für Innere Medizin III (Hämatologie und Internistische Onkologie) |
| Depositing User: | Dr. Gernot Deinzer |
| Date Deposited: | 06 Aug 2025 06:28 |
| Last Modified: | 06 Aug 2025 06:28 |
| URI: | https://pred.uni-regensburg.de/id/eprint/65695 |
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