A systematic literature review of incidence, mortality, and relapse of patients diagnosed with chronic graft versus host disease

ABSTRACT

Introduction: Chronic graft-versus-host disease (chronic GVHD) is a leading cause of late death and contributes significantly to morbidity following hematopoietic stem cell transplantation. This study aims to provide a systematic literature review on incidence, mortality, and relapse of chronic GVHD patients.

Areas covered: The authors searched for English-language articles published between 2007 and 2017 using PubMed. Studies that applied the 2005 or 2015 NIH Consensus Criteria for the diagnosis and staging of chronic GVHD, and had a cohort size of at least 100 patients were included.

Expert opinion: The authors found a wide variation of incidence rates, which can be explained by heterogeneity in the characteristics of study samples and applied transplantation protocols. Chronic GVHD was associated with higher non-relapse mortality (NRM), superior overall survival (OS) and lower risk of relapse. Studies indicated an increased risk for NRM and worse OS in the presence of more severe disease. Future therapies should focus to reach a delicate balance between controlling disease severity among patients diagnosed with chronic GVHD and preserving the graft versus tumor effect which goes along with chronic GVHD and results in improved OS and decreased relapse rate. Nonetheless, factors predicting disease severity still need to be further understood.

KEYWORDS:

• Chronic graft-versus-host disease
• clinical burden
• cumulative incidence
• non-relapse mortality
• overall survival
• relapse incidence
• systematic literature review

Article highlights

• Chronic GVHD is common, serious and potentially life-threating complication after allogeneic hematopoietic stem cell transplantation, and its development is affected by many factors.

• There is a limited evidence regarding predictors of disease severity therefore, systematic investigation of this issue in the future is recommended.

• Non-relapse mortality due to chronic GVHD is substantial, and it is increased in patients with more severe chronic GVHD.

• There is an improved overall survival among chronic GVHD patients compared to those without chronic GVHD due to graft versus tumor effect. Most studies demonstrated better survival for patients with mild compared to moderate or severe chronic GVHD.

Declaration of interest

M Csanadi and T Agh are employees of Syreon Research Institute. Syreon Research Institute received grant support from Janssen Global Services, LLC to conduct the study. A Tordai is a recipient of ‘Felsöoktatási Intézménnyi Kiválósági Program’ grant and received an expert fee from Syreon Research Institute to participate in the study. T Webb and D Jeyakumaran were employees of Janssen at the time of the preparation of the manuscript. N Sengupta is an employee of Janssen and Johnson and Johnson. F Schain is an employee of Janssen, Johnson and Johnson and is also a shareholder of Johnson and Johnson stocks. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or conflict with the subject matter or materials discussed in this manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed here.

Additional information

Funding

This research was financially supported by Janssen Global Services, LLC.