Burden of hospitalizations and outpatient visits associated with moderate and severe acute graft-versus-host disease in Finland and Sweden: a real-world data study

Lorenzo Sabatelli,Malin Nicklasson,Maija Itälä-Remes,Nuria Lara,Mikko Keränen,Minja Pfeiffer,Daniel Thunström,Elisabet Viayna,Montserrat Roset

doi:10.1007/s00520-022-06915-9

Lorenzo Sabatelli, Malin Nicklasson + Show 7 more

Open Access

https://doi.org/10.1007/s00520-022-06915-9

Copy DOI

Abstract

PurposeThe aim of this study was to describe patient characteristics and quantify hospital stays and outpatient visits (H&OV) following diagnosis with moderate-to-severe acute graft-versus-host disease (aGVHD) in Finland and Sweden.MethodsA retrospective chart audit collected data from patient medical records of 3 specialized centers performing allogeneic hematopoietic stem cell transplantation (HSCT; Finland, n = 2; Sweden, n = 1). Eligible patients received allogeneic HSCT (January 1, 2016–June 30, 2017) from any donor source, were diagnosed with grade II–IV aGVHD (MAGIC or modified Glucksberg criteria) at any time from transplantation to 12 months before data collection, and were ≥ 18 years old at diagnosis. Criteria for comparing patients graded with modified Glucksberg and MAGIC severity scales were defined.ResultsFifty-five patients (Finland, n = 45; Sweden, n = 10) were included. Myeloablative conditioning was the most common conditioning regimen (81.8%); immunosuppression regimens were based on combinations of methotrexate (96.4%), in vivo T-cell depletion (80.0%), cyclosporine (63.6%), mycophenolate (40.0%), and tacrolimus (34.5%). Sixteen patients (29.1%) developed grade III/IV aGVHD; skin was the most common organ involved (80.0%). Most patients required ≥ 1 hospital stay (89.1%; median of 2 hospitalizations per patient); 7 patients (14.3%) required admission to an intensive care unit. Median hospitalization duration from HSCT to discharge was 26 days. Most patients also required outpatient or emergency department visits (90.9%). Subgroup analyses showed longer hospital stays for patients receiving multiple treatment lines; no clear differences in H&OV were observed between prophylactic regimens.ConclusionBased on this retrospective study, moderate-to-severe aGVHD is associated with considerable healthcare resource utilization in Finland and Sweden, particularly in patients who received multiple lines of therapy.

Highlights

Graft-versus-host disease (GVHD), a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT), is a clinical syndrome caused by the response of alloreactive donor T cells to histocompatibility antigens expressed on tissues of the transplant recipient [1, 2]
Study eligibility criteria included receipt of a first allogeneic HSCT between January 1, 2016, and June 30, 2017, from any donor source using bone marrow, peripheral blood stem cells (PBSCs), or umbilical cord blood; diagnosis of grade II–IV acute GVHD (aGVHD) based on Mount Sinai Acute GVHD International Consortium (MAGIC) criteria [18] (or alternatively, a II–IV severity grade per the Glucksberg Severity Index or the Keystone Criteria [19], or grade B–D according to International Blood and Marrow Transplant Research (IBMTR) criteria [20]) any time from transplantation to 12 months before data collection; and age ≥ 18 years at the time of aGVHD diagnosis
There were approximately 50 patients in Finland and 80 patients in Sweden who developed grade II to IV aGVHD after HSCT from January 1, 2016, to June 30, 2017

Summary

Introduction

Graft-versus-host disease (GVHD), a serious complication of allogeneic hematopoietic stem cell transplantation (HSCT), is a clinical syndrome caused by the response of alloreactive donor T cells to histocompatibility antigens expressed on tissues of the transplant recipient [1, 2]. The European Society for Blood and Marrow Transplantation and National Institutes of Health Center for International Blood and Marrow Transplant Research (EBMT–NIH-CIBMTR) joint classification for acute GVHD (aGVHD) includes classic aGVHD, defined by the occurrence of aGVHD manifestations within 100 days after transplantation or donor lymphocyte infusion (DLI), as well as persistent, recurrent, or late-onset forms of aGVHD, which occur beyond 100 days posttransplantation or after DLI [3, 4]. Despite routine use of prophylactic regimens, aGVHD occurs in 30 to 60% of patients undergoing allogeneic HSCT [6, 7]. Up to 60% of patients do not respond adequately to steroids [8–11]. For these patients, a choice of second-line therapy remains controversial

Objectives

Methods

Results

Conclusion