Abstract
Chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplantation (HCT) is associated with systemic inflammation and endothelial dysfunction, increasing risk for thromboembolic events (TEE). In 145 adult recipients who developed cGVHD after a matched sibling or umbilical cord blood donor HCT from 2010 to 2018, 32(22%) developed at least 1 TEE event, and 14(10%) developed 2 TEE events. The 5-year cumulative incidence of TEE was 22% (95% CI, 15–29%) with a median time from cGVHD to TEE of 234 days (range, 12–2050). Median time to the development of LE DVT or PE was 107 (range, 12–1925) compared to 450 days (range, 158–1300) for UE DVT. Cumulative incidence of TEE was 9% (95% CI, 0–20%), 17% (95% CI, 9–25%), and 38% (95% CI, 22–55%) in those with mild, moderate, and severe GVHD, respectively. Higher risk for TEE was associated with cGVHD severity (hazard ratio [HR] 4.9, [95% CI, 1.1–22.0]; p = 0.03), non-O-donor to recipient ABO match compared to O-donor to O-recipient match (HR 2.7, [95% CI, 1.0–7.5]; p = 0.053), and personal history of coronary artery disease (HR 2.4, [95% CI, 1.1–5.3]; p = 0.03). TEE was not associated with 2-year non-relapse mortality or 5-year overall survival.
Highlights
Chronic graft-versus-host disease occurs in up to half of allogeneic HCT recipients, limits the success of allogeneic hematopoietic cell transplantation (HCT), and remains the leading cause of non-relapse mortality (NRM) and morbidity among survivors. cGVHD is a multisystem syndrome involving dysregulated immunity, tissue inflammation and injury, with endothelial dysfunctionEl Jurdi et al Blood Cancer Journal (2021)11:96 often resembling processes seen in autoimmune diseases and possibly leading to permanent organ damage[1,2,3,4].Venous and arterial thromboembolism is pathologic formation of thrombi in organs, often associated with inflammation
We examined the effect of traditional thromboembolic events (TEE) risk factors including smoking history, diabetes mellitus (DM), hyperlipidemia (HLD), hypertension (HTN), cerebrovascular accident (CVA), congestive heart failure (CHF), coronary artery disease (CAD), family history of TEE, and personal history of TEE prior to cGVHD diagnosis
The cumulative incidence of TEE through 5 years post cGVHD diagnosis was estimated at 22% with a median time from cGVHD to TEE of 234 days
Summary
Chronic graft-versus-host disease (cGVHD) occurs in up to half of allogeneic HCT recipients, limits the success of allogeneic hematopoietic cell transplantation (HCT), and remains the leading cause of non-relapse mortality (NRM) and morbidity among survivors. cGVHD is a multisystem syndrome involving dysregulated immunity, tissue inflammation and injury, with endothelial dysfunctionEl Jurdi et al Blood Cancer Journal (2021)11:96 often resembling processes seen in autoimmune diseases and possibly leading to permanent organ damage[1,2,3,4].Venous and arterial thromboembolism is pathologic formation of thrombi in organs, often associated with inflammation. Chronic graft-versus-host disease (cGVHD) occurs in up to half of allogeneic HCT recipients, limits the success of allogeneic hematopoietic cell transplantation (HCT), and remains the leading cause of non-relapse mortality (NRM) and morbidity among survivors. CGVHD is a multisystem syndrome involving dysregulated immunity, tissue inflammation and injury, with endothelial dysfunction. Venous and arterial thromboembolism is pathologic formation of thrombi in organs, often associated with inflammation. Limited studies have reported a wide range of thromboembolism incidence among allogeneic HCT recipients[10,11,12,13], with higher risk observed in patients developing GVHD12,13. We aim to assess the incidence and risk factors for thromboembolic events (TEE), including venous thromboembolism (VTE) and pulmonary embolism (PE), among patients with known cGVHD and examine the impact of TEE on clinical outcomes after cGVHD
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
