Steroid-refractory acute graft-versus-host disease graded III-IV in pediatric patients. A mono-institutional experience with a long-term follow-up
Corresponding Author
Massimo Berger
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Correspondence
Massimo Berger, Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy.
Emails: [email protected]; [email protected]
Search for more papers by this authorRosanna Pessolano
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorFrancesca Carraro
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorFrancesco Saglio
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorElena Vassallo
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorFranca Fagioli
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorCorresponding Author
Massimo Berger
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Correspondence
Massimo Berger, Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy.
Emails: [email protected]; [email protected]
Search for more papers by this authorRosanna Pessolano
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorFrancesca Carraro
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorFrancesco Saglio
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorElena Vassallo
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorFranca Fagioli
Pediatric Onco-Hematology, City of Health and Science, Regina Margherita Children Hospital, University of Turin, Turin, Italy
Search for more papers by this authorAbstract
aGvHD remains a major obstacle to successful HSCT. We report our experience on steroid-refractory aGvHD III and IV from 1989 to 2017. Ninety patients with aGvHD III or IV were stratified according to the HSCT year: 1989-1998, 1999-2007, and 2008-2017 and to aGvHD extension (GvHD III vs IV) and finally the probability of OS, RI, and TRM was calculated accordingly. aGvHD III patients had a substantial improvement over time: day 100 OS raised from 64% (95% CI 39-89) in the first cohort to 100% in the latest (P = .022), and it was mainly due to a reduction of TRM (it was 28% [95% CI 12-65] in the first cohort to 0% in the latest (P = .01). The aGvHD IV patients did not present a significant improvement. Day 100 OS was 42% (95% CI 16-68) in the first group and 54% (95% CI 25-83) in the year 2008-2017 (P = NS), and the day-100 TRM was very similar (it was 57% [95% CI 36-90] in the first cohort and 45% [95% CI 23-89] in the latest (P = NS). We report significant improvements in OS and TRM in patients diagnosed with grade III aGvHD. Patients with the most severe aGvHD appear to have no or fewer benefits on long-term outcomes.
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