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Ringden, O.; Labopi, M.; Sadeghi, B.; Mailhol, A.; Beelen, D.; Floisand, Y.; Ghavamzadeh, A.; Finke, J.; Ehninger, G.; Volin, L.; Socie, G.; Kröger, N.; Stuhler, G.; Ganser, A.; Schmid, C.; Giebel, S.; Mohty, M.; Nagler, A. (2018): What is the outcome in patients with acute leukaemia who survive severe acute graft-versus-host disease? In: Journal of Internal Medicine, Vol. 283, No. 2: pp. 166-177
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Abstract

Background: Acute graft-versus-host disease (aGVHD) is a major complication of allogeneic haematopoietic stem cell transplantation (HSCT). With new promising therapies, survival may improve for severe aGVHD. Objective: We wanted to analyze the long-term outcome in patients who survive severe aGVHD. Methods: This study was a landmark analysis of 23 567 patients with acute Leukaemia who survived for more than 6 months after HSCT, 2002-2014. Patients alive after severe aGVHD (n = 1738) were compared to controls. Results: Patients with severe aGVHD had higher non-relapse mortality (NRM) and higher rate of extensive chronic GVHD (cGVHD) than the controls (P < 10(-5)). The probability of relapse was significantly lower in the severe aGVHD group, but Leukaemia-free survival (LFS) and overall survival were significantly lower than for the controls (P < 10(-5)). Five-year LFS in patients with severe aGVHD was 49%, as opposed to 61% in controls with no or mild GVHD and 59% in patients with moderate GVHD. Conclusion: sHSCT patients who survive severe aGVHD have higher risk of developing extensive cGVHD, a higher NRM, a lower relapse probability, and lower LFS than other HSCT patients. This study is a platform for outcome analysis in patients treated with novel therapies for acute GVHD.