Page 49 - Haematologica May 2022

Improved survival after acute GvHD
with a lower incidence. Of note is that aGvHD grades II-IV decreased with increasing transplant year (HR 0.57 (0.55-0.59); P<0.001), even in patients treated without ATG or alemtuzumab. The increased risk of aGvHD due to an increase in age was minimally reduced in more recent transplant years (per year: HR = 0.99 (0.99-1.0), P=0.05).
Incidences of aGvHD grades III-IV by 100 days signifi-
cantly decreased from 19% (18-20%), to 16% (16-17%), 13% (13-14%), 11% (11-12%), and 11% (11-11%) for the periods 1990-1995, 1996-2000, 2001-2005, 2006-2010, and 2011-2015, respectively (Figure 1B).
In multivariate analysis, URD (HR 1.52 (1.43-1.62); P<0.001), not in CR at HSCT (HR 1.5 (1.41-1.6); P<0.001) or untreated (HR 1.29 (1.13-1.46); P<0.001), use of BM instead of PBSC as stem cell source (HR 1.08; 1.01-1.16;
AB
Figure 1. Incidences of aGvHD grades II-IV and grades III-IV over time. (A) Incidences of aGvHD grades II-IV over time. Cumulative incidence estimates were calculated for aGvHD grades II-IV with mortality considered as a competing event. The endpoint aGvHD grades II-IV was estimated from the date of first transplantation. Data are shown according to transplantation periods 1990-1995, 1996-2000, 2001-2005, 2006-2010 and 2011-2015. (B) Incidences of aGvHD grades III-IV over time. Cumulative incidence estimates were calculated for aGvHD grades III-IV with mortality considered as a competing event. The endpoint aGvHD grades III-IV was esti- mated from the date of first transplantation. Data are shown according to transplantation periods 1990-1995, 1996-2000, 2001-2005, 2006-2010 and 2011-2015.
Table 2. Multivariable Cox regression analysis regarding acute GvHD grades II-IV. aGvHD II-IV
aGvHD III-IV
Age at HSCT (dec) Conditioning intensity
Donor/recipient relationship Disease status at HSCT
Stem cell source Recipient/donor sex match
ATG/Alemtuzumab
Standard Reduced Related Unrelated CR noCR untreated PB BM MM MF FM
FF
No Yes
HR (95% CI)
1.02 (1-1.03)
0.93 (0.9-0.97)
1.61 (1.54-1.67)
1.25 (1.2-1.3) 1.11 (1.02-1.2)
1.2 (1.15-1.25)
1.16 (1.11-1.21) 0.93 (0.89-0.98) 1.03 (0.98-1.08)
0.79 (0.74-0.84) 0.57 (0.55-0.59) 0.97 (0.92-1.03)
P
0.022
0.001
<0.001
<0.001 0.02
<0.001
<0.001 0.002 0.3
<0.001 <0.001 0.4
HR (95% CI)
1.02 (1-1.04)
0.88 (0.83-0.94)
1.52 (1.43-1.62)
1.5 (1.41-1.6) 1.29 (1.13-1.46)
1.08 (1.01-1.16)
1.2 (1.12-1.29) 0.87 (0.81-0.94) 0.89 (0.82-0.96)
1.03 (0.95-1.12) 0.56 (0.53-0.6) 0.73 (0.67-0.8)
P
0.11
<0.001
<0.001
<0.001 <0.001
0.029
<0.001 <0.001 0.004
0.5 <0.001 <0.001
HSCT year (dec)
ATG/Alemtuzumab x HSCT year (dec)
OS: overall survival; DFS: disease-free survival; NRM: non-relapse mortality; CR: complete remission; BM: bone marrow; PBSC: peripheral blood stem cells; ATG: antithymocyte globulin; HSCT: hematopoietic stem cell transplantation.
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