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Gastrointestinal involvement refines prognosis in minnesota standard risk acute graft-vs.-host disease

Bone Marrow Transplantation (2024)Cite this article

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Abstract

Minnesota acute graft versus host disease (AGVHD) risk score is a validated tool to stratify newly-diagnosed patients into standard-risk (SR) and high-risk (HR) groups with ~85% having SR AGVHD. We aimed to identify factors for further risk-stratification within Minnesota SR patients. A single-center, retrospective analysis of consecutive patients between 1/2010 and 12/2014 was performed. Patients who developed AGVHD within 100 days and treated with systemic corticosteroids were included (N = 416), 356 (86%) of which were Minnesota SR and 60 (14%) had HR AGVHD. Isolated upper gastrointestinal (GI) AGVHD patients had significantly better day 28 and 56 CR/PR rates (90% vs. 72%, p = 0.004) and (83% vs 66%, p = 0.01), respectively, and lower 1-year non-relapse mortality (NRM; 10% vs. 22%; HR 0.4, p = 0.03). Lower GI AGVHD had less favorable outcomes with 1-year NRM of 40% (HR 2.1, p = 0.001), although CR/PR rates were not statistically different. In multivariate analysis, lower GI involvement (HR 2.6, p < 0.001), age ≥ 50 (HR 2.9, p < 0.001) and HCT-CI > 3 (HR 2.1, p = 0.002) predicted for 1-year NRM. Heterogeneity within Minnesota SR patients requires consideration in clinical trials, as distinct outcomes are observed in those with isolated upper GI and lower GI AGVHD, highlighting the importance of stratification in clinical trial design.

Highlights

  • Patients with Minnesota standard risk (SR) acute GVHD with isolated upper gastrointestinal involvement have excellent outcomes

  • Patients with lower gastrointestinal involvement have significantly worse NRM.

  • GI involvement can further refine the heterogeneity within the Minnesota SR patients.

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Fig. 1: Distribution of day 28 response according to Minnesota risk group and organ involvement.
Fig. 2

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Data availability

Datasets of the analysis reported in this study are available from the corresponding author on reasonable request.

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Authors and Affiliations

  1. Division of Hematology, Dalhousie University, Halifax, NS, Canada

    Curtis M. Marcoux

  2. Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Amin M. Alousi, Jin Im, Portia Smallbone, George Chen, Muzaffar Qazilbash, Elizabeth Shpall, Richard C. Champlin & Rima M. Saliba

  3. Center for Cell and Gene Therapy, Baylor College of Medicine, Houston, TX, USA

    Laquisa C. Hill, Uday Popat, Chitra Hosing, Partow Kebriaei & Amanda Olson

  4. Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA, USA

    Rohtesh Mehta

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Contributions

AMA and RMS conceived and designed the study. CM, AMA, LCH, and RMS collected and assembled the data. CM, AMA, and RMS wrote the manuscript. CM, AMA, JI, LCH, PS, UP, CH, PK, AO, RM, GC, MQ, ES, RCC, and RMM interpreted the data, approved the article and are accountable for publication.

Corresponding author

Correspondence to Amin M. Alousi.

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Marcoux, C.M., Alousi, A.M., Im, J. et al. Gastrointestinal involvement refines prognosis in minnesota standard risk acute graft-vs.-host disease. Bone Marrow Transplant (2024). https://doi.org/10.1038/s41409-024-02393-1

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