Overlap subtype of chronic graft-versus-host disease is associated with an adverse prognosis, functional impairment, and inferior patient-reported outcomes: A Chronic Graft-versus-Host Disease Consortium study

Authors

Joseph Pidala
Georgia Vogelsang
Paul MartinFollow
Xiaoyu Chai, Fred Hutchinson Cancer Research Center, Seattle, WA
Barry StorerFollow
Steven Pavletic
Daniel Weisdorf, University of MinnesotaFollow
Madan Jagasia
Corey Cutler
Jeanne Palmer
David Jacobsohn, George Washington UniversityFollow
Sally Arai
Stephanie J. Lee

Document Type

Journal Article

Publication Date

3-1-2012

Journal

Haematologica

Volume

Volume 97, Issue 3

Inclusive Pages

451-458

Keywords

Graft vs Host Disease--diagnosis

Abstract

Background

The National Institutes of Health Consensus Conference proposed the term “overlap” graft-versus-host disease to describe the situation when both acute and chronic graft-versus-host disease are present.

Design and Methods

We examined whether the overlap subtype of graft-versus-host disease was associated with a different prognosis, functional limitations, or patient-reported outcomes compared to “classic” chronic graft-versus-host disease without any acute features.

Results

Prospective data were collected from 427 patients from nine centers. Patients were classified as having overlap (n=352) or classic chronic (n=75) graft-versus-host disease based on reported organ involvement. Overlap cases had a significantly shorter median time from transplantation to cohort enrollment (P=0.01), were more likely to be incident cases (P<0.001), and had a lower platelet count at onset of the graft-versus-host disease (P<0.001). Patients with overlap graft-versus-host disease had significantly greater functional impairment measured by a 2-minute walk test, higher symptom burden and lower Human Activity Profile scores. Quality of life was similar, except patients with overlap graft-versus-host disease had worse social functioning, assessed by the Short Form-36. Multivariable analysis utilizing time-varying covariates demonstrated that the overlap subtype of graft-versus-host disease was associated with worse overall survival (HR 2.1, 95% CI 1.1–4.7; P=0.03) and higher non-relapse mortality (HR 2.8, 95% CI 1.2–8.3; P=0.02) than classic chronic graft-versus-host disease.

Conclusions

These findings suggest that the presence of acute features in patients with chronic graft-versus-host disease is a marker of adverse prognosis, greater functional impairment, and higher symptom burden.

Comments

Obtained from Haematologica: http://www.haematologica.org.

Creative Commons License

This work is licensed under a Creative Commons Attribution 3.0 License.

APA Citation

Pidala, J., Vogelsang, G., Martin, P., Chai, X., Storer, B. et al. (2012). Overlap subtype of chronic graft-versus-host disease is associated with an adverse prognosis, functional impairment, and inferior patient-reported outcomes: a Chronic Graft-versus-Host Disease Consortium study. Haematologica, 97(3), 451-458.

Peer Reviewed

1

Open Access

1