open access

Vol 52, No 5 (2021)
Original research article
Submitted: 2021-09-15
Accepted: 2021-09-15
Get Citation

Graft-versus-host disease in patients treated with allogenic hematopoetic cell transplantation: experience from North Macedonia

Ivana Mickovski123, Daniela Bukliovska Ilievska12, Borce Georgievski2, Taner Hasan1, Natasha Nedeska Minova1, Radmila Neshovska1, Daniela Doneva1
DOI: 10.5603/AHP.2021.0090
·
Acta Haematol Pol 2021;52(5):509-515.
Affiliations
  1. September 8th, City General Hospital, Skopje, North Macedonia
  2. Medical Faculty, University “St. Cyril and Methodius”, Skopje, North Macedonia
  3. Faculty of Medical Science at the University “Goce Delcev”, Štip, North Macedonia

open access

Vol 52, No 5 (2021)
ORIGINAL RESEARCH ARTICLE
Submitted: 2021-09-15
Accepted: 2021-09-15

Abstract

Introduction: Graft-versus-host disease (GvHD) is the major complication arising after allogeneic hematopoietic cell transplantation (allo-HCT). It can be presented as acute and/or chronic GvHD. The purpose of this study was describe the incidence of acute and chronic GvHD in patients treated with allo-HCT. Materials and methods: This study was designed as a retrospective study, which included 65 patients treated with allogeneic transplantation from human leukocyte antigen identical donor at University Clinic of Hematology in Skopje, North Macedonia. Results: Acute GvHD (aGvHD) was observed in 28 patients, with the most common localization on the skin (75%). Post-transplant phase had significant effect on the frequency of skin aGvHD (p =0.038). Also statistically significant difference was confirmed between patients with and without acute skin GvHD in terms of conditioning regimen (p =0.034). Chronic GvHD (cGvHD) was diagnosed in 10 patients, mostly progressing from the previous acute GvHD (9.23%). Post-transplant phase had also significant effect on the frequency of skin cGvHD (p =0.018). Patients with higher European Society for Blood and Marrow Transplantation risk score had significantly more frequent skin cGvHD than the others. Conclusions: Acute and chronic GvHD were one of the main causes of morbidity and mortality of patients after aloo-HCT. GvHD remains a major risk for patients with allo-HCT regardless of diagnosis and type of transplantation.

Abstract

Introduction: Graft-versus-host disease (GvHD) is the major complication arising after allogeneic hematopoietic cell transplantation (allo-HCT). It can be presented as acute and/or chronic GvHD. The purpose of this study was describe the incidence of acute and chronic GvHD in patients treated with allo-HCT. Materials and methods: This study was designed as a retrospective study, which included 65 patients treated with allogeneic transplantation from human leukocyte antigen identical donor at University Clinic of Hematology in Skopje, North Macedonia. Results: Acute GvHD (aGvHD) was observed in 28 patients, with the most common localization on the skin (75%). Post-transplant phase had significant effect on the frequency of skin aGvHD (p =0.038). Also statistically significant difference was confirmed between patients with and without acute skin GvHD in terms of conditioning regimen (p =0.034). Chronic GvHD (cGvHD) was diagnosed in 10 patients, mostly progressing from the previous acute GvHD (9.23%). Post-transplant phase had also significant effect on the frequency of skin cGvHD (p =0.018). Patients with higher European Society for Blood and Marrow Transplantation risk score had significantly more frequent skin cGvHD than the others. Conclusions: Acute and chronic GvHD were one of the main causes of morbidity and mortality of patients after aloo-HCT. GvHD remains a major risk for patients with allo-HCT regardless of diagnosis and type of transplantation.

Get Citation

Keywords

allogeneic transplantation, acute and chronic GvHD, conditioning regimen, donor-recipient match, immune system

About this article
Title

Graft-versus-host disease in patients treated with allogenic hematopoetic cell transplantation: experience from North Macedonia

Journal

Acta Haematologica Polonica

Issue

Vol 52, No 5 (2021)

Article type

Original research article

Pages

509-515

Page views

3269

Article views/downloads

178

DOI

10.5603/AHP.2021.0090

Bibliographic record

Acta Haematol Pol 2021;52(5):509-515.

Keywords

allogeneic transplantation
acute and chronic GvHD
conditioning regimen
donor-recipient match
immune system

Authors

Ivana Mickovski
Daniela Bukliovska Ilievska
Borce Georgievski
Taner Hasan
Natasha Nedeska Minova
Radmila Neshovska
Daniela Doneva

References (26)
  1. Devergie A. Graft-versus-host disease. In: Apperley J, Carreras E, Gluckman E, Masszi T T. ed. ESH-EBMT handbook on haematopoietic stem cell transplantation. European School of Haematology, Paris 2012: 216–233.
  2. Caballero-Velázquez T, Sánchez-Abarca LI, Gutierrez-Cosio S, et al. The novel combination of sirolimus and bortezomib prevents graft-versus-host disease but maintains the graft-versus-leukemia effect after allogeneic transplantation. Haematologica. 2012; 97(9): 1329–1337.
  3. Gooptu M, Koreth J. Better acute graft-versus-host disease outcomes for allogeneic transplant recipients in the modern era: a tacrolimus effect? Haematologica. 2017; 102(5): 806–808.
  4. Rubio MT, Labopin M, Blaise D, et al. The impact of graft-versus-host disease prophylaxis in reduced-intensity conditioning allogeneic stem cell transplant in acute myeloid leukemia: a study from the Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation. Haematologica. 2015; 100(5): 683–689.
  5. Nikiforow S, Wang T, Hemmer M, et al. GV12-02 Writing Committee on behalf of the CIBMTR® Graft-versus-Host Disease Working Committee. Upper gastrointestinal acute graft-versus-host disease adds minimal prognostic value in isolation or with other graft--host disease symptoms as currently diagnosed and treated. Haematologica. 2018; 103(10): 1708–1719.
  6. Zeiser R, Blazar BR. Acute graft-versus-host disease — biologic process, prevention, and therapy. N Engl J Med. 2017; 377(22): 2167–2179.
  7. Bacigalupo A, Milone G, Cupri A, et al. Gruppo Italiano Trapianto di Midollo Osseo (GITMO). Steroid treatment of acute graft-versus-host disease grade I: a randomized trial. Haematologica. 2017; 102(12): 2125–2133.
  8. Betts BC, Pidala J, Kim J, et al. IL-2 promotes early Treg reconstitution after allogeneic hematopoietic cell transplantation. Haematologica. 2017; 102(5): 948–957.
  9. Khoury HJ, Wang T, Hemmer MT, et al. Improved survival after acute graft-versus-host disease diagnosis in the modern era. Haematologica. 2017; 102(5): 958–966.
  10. Drobyski WR, Szabo A, Zhu F, et al. Tocilizumab, tacrolimus and methotrexate for the prevention of acute graft--host disease: low incidence of lower gastrointestinal tract disease. Haematologica. 2018; 103(4): 717–727.
  11. Rubio MT. eGVHD App: a new tool to improve graft-versus-host disease assessment. Haematologica. 2018; 103(10): 1583–1585.
  12. Baron F, Mohty M, Blaise D, et al. Anti-thymocyte globulin as graft-versus-host disease prevention in the setting of allogeneic peripheral blood stem cell transplantation: a review from the Acute Leukemia Working Party of the European Society for Blood and Marrow Transplantation. Haematologica. 2017; 102(2): 224–234.
  13. Eefting M, von dem Borne PA, de Wreede LC, et al. Intentional donor lymphocyte-induced limited acute graft-versus-host disease is essential for long-term survival of relapsed acute myeloid leukemia after allogeneic stem cell transplantation. Haematologica. 2014; 99(4): 751–758.
  14. Ringdén O, Remberger M, Ruutu T, et al. Increased risk of chronic graft-versus-host disease, obstructive bronchiolitis, and alopecia with busulfan versus total body irradiation: long-term results of a randomized trial in allogeneic marrow recipients with leukemia. Blood. 1999; 93(7): 2196–2201.
  15. Pidala J, Kim J, Alsina M, et al. Prolonged sirolimus administration after allogeneic hematopoietic cell transplantation is associated with decreased risk for moderate-severe chronic graft-versus-host disease. Haematologica. 2015; 100(7): 970–977.
  16. Ditschkowski M, Elmaagacli AH, Trenschel R, et al. Dynamic International Prognostic Scoring System scores, pre-transplant therapy and chronic graft-versus-host disease determine outcome after allogeneic hematopoietic stem cell transplantation for myelofibrosis. Haematologica. 2012; 97(10): 1574–1581.
  17. Kheav VD, Busson M, Scieux C, et al. Favorable impact of natural killer cell reconstitution on chronic graft-versus-host disease and cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation. Haematologica. 2014; 99(12): 1860–1867.
  18. Gandelman JS, Byrne MT, Mistry AM, et al. Machine learning reveals chronic graft-versus-host disease phenotypes and stratifies survival after stem cell transplant for hematologic malignancies. Haematologica. 2019; 104(1): 189–196.
  19. Lee SJ, Onstad L, Chow EJ, et al. Patient-reported outcomes and health status associated with chronic graft-versus-host disease. Haematologica. 2018; 103(9): 1535–1541.
  20. Shokouhi S, Bray S, Bakhtiyari S, et al. Effects of aGVHD and cGVHD on survival rate in patients with acute myeloid leukemia after allogeneic stem cell transplantation. Int J Hematol Oncol Stem Cell Res. 2015; 9(3): 112–121.
  21. Gratwohl A, Stern M, Brand R, et al. European Group for Blood and Marrow Transplantation and the European Leukemia Net. Risk score for outcome after allogeneic hematopoietic stem cell transplantation: a retrospective analysis. Cancer. 2009; 115(20): 4715–4726.
  22. Glucksberg H, Storb R, Fefer A, et al. Clinical manifestations of graft-versus-host disease in human recipients of marrow from HL-A-matched sibling donors. Transplantation. 1974; 18(4): 295–304.
  23. McSweeney PA, Niederwieser D, Shizuru JA, et al. Hematopoietic cell transplantation in older patients with hematologic malignancies: replacing high-dose cytotoxic therapy with graft-versus-tumor effects. Blood. 2001; 97(11): 3390–3400.
  24. Ruggeri A, Sun Y, Labopin M, et al. Post-transplant cyclophosphamide versus anti-thymocyte globulin as graft- versus-host disease prophylaxis in haploidentical transplant. Haematologica. 2017; 102(2): 401–410.
  25. Schoemans HM, Goris K, Van Durm R, et al. EBMT Transplantation Complications Working party. The eGVHD App has the potential to improve the accuracy of graft-versus-host disease assessment: a multicenter randomized controlled trial. Haematologica. 2018; 103(10): 1698–1707.
  26. Kim HT, Zhang MJ, Woolfrey AE, et al. Donor and recipient sex in allogeneic stem cell transplantation: what really matters. Haematologica. 2016; 101(10): 1260–1266.

Regulations

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Via Medica Publishers

ul. Świętokrzyska 73, 80–180 Gdańsk, Poland
phone +48 58 320 94 94, fax+48 58 320 94 60,

e-mail: journals@viamedica.pl