Classifying Patient Reponses to Steroid Therapy for Acute GVHD May Improve Outcomes

Nonrelapse mortality (NRM) and morbidity rates in patients who undergo allogeneic hematopoietic stem cell transplantation (HCT) can often be traced back to acute graft-versus-host disease (aGVHD). After initial corticosteroid therapy, patient responses can be grouped into 1 of 3 categories: steroid sensitive (SS), steroid resistant (SR), and steroid dependent (SD). Understanding these categories better can help guide treatments, according to a recent article in Blood Advances.

The researchers enrolled 1143 adult and pediatric allogeneic HCT recipients from a single institution, the University of Minnesota, and conducted a retrospective cohort study to assess risk factors, incidence, and clinical outcomes of patients with aGVHD after undergoing first-line treatment with corticosteroids. They especially wanted to learn more about steroid-dependent aGVHD, which has a more uncertain prognosis than steroid-resistant aGVHD, which is typically associated with high NRM.

Eventually, 385 patients developed aGVHD, each of whom received initial therapy with oral prednisone, approximately 2 mg/kg per day (adults) or 60 mg/m² per day (children), or the intravenous equivalent of methylprednisolone, for a 2-week course. Treatment was tapered down over 8 weeks after the initial therapy.

Patients were assessed to classify GVHD response to treatment. Of the cases of aGVHD, 114 were classified as steroid sensitive, 103 as steroid dependent, and 168 as steroid resistant. Additional findings include:

• Malignant disease, donor type, and older age were associated with SR GVHD.
• The 2-year overall survival was much lower in patients in the SR group (46%) than in patients from the SS and SD groups (both 68%).
• People with SD aGVHD seemed to have a higher risk of developing chronic GVHD; the incidence rate was 46%, compared with 41% for the SR group and 29% for the SS group.
• Certain factors associated with advanced SD and SR aGVHD, such as patient age, cannot be modified, and other risk factors, such as donor choice and choice of conditioning regimen, which is often dependent on previous therapies and comorbidities as well as age, may not be easily modified.

Gleaning this type of information about aGVHD responses in various patients may help better tailor the management of aGVHD in patients in the future.  

“Refining aGVHD into these 3 response groups, each having different risk factors and prognosis, could be used to guide future therapeutic strategies,” the team of researchers concluded.

Disclosure: Multiple authors declared affiliations with and/or received funding from the pharmaceutical industry. Please refer to the original article for a full list of disclosures.

Reference

El Jurdi N, Rayes A, MacMillan ML, et al. Steroid-dependent acute GVHD after allogeneic hematopoietic cell transplantation: risk factors and clinical outcomes. Blood Adv. 2021;5(5):1352-1359. doi:10.1182/bloodadvances.2020003937