Malnutrition is a known complication of chronic GVHD (cGVHD), but has not been well described in the context of organ-specific manifestations and the recent National Institutes of Health (NIH) criteria. Here, 210 cGVHD patients were analyzed, in a cross-sectional study design, for demographics, transplant-related history, clinical assessments, symptoms, function, quality-of-life, laboratory values and survival in order to determine their associations with nutritional status. Most patients had long-standing, moderate or severe cGVHD and had failed many lines of therapy. Twenty-nine percent (60/210) of subjects were malnourished, using the subjective Patient-Generated Subjective Global Assessment (PG-SGA) questionnaire and evaluation. No demographic or transplant characteristics were associated with malnutrition; cGVHD of the lungs, gastrointestinal (GI) tract and mouth, NIH global score, cGVHD symptoms, worse functioning, low albumin, poorer survival and low BMI were associated with malnutrition. A predictive model was developed from all variables of significance: cGVHD of the lungs, GI tract, mouth and BMI accurately predicted 84.2% of malnourished patients as well as 87.2% of well-nourished patients. The PG-SGA questionnaire may be a useful tool in diagnosing nutritional deficits in cGVHD patients undergoing one-time evaluations. Longitudinal prospective studies should assess the utility of nutritional support interventions in cGVHD.

The NIH Chronic Graft-versus-Host Disease (cGVHD) Consensus Project Ancillary and Supportive Care Guidelines recommend annual assessment of bone mineral density (BMD) to monitor bone health. The study of osteoporosis in patients with cGVHD has been limited to small numbers of patients and the guidelines are based on experiences in other chronic diseases and expert opinion. We hypothesized that the prevalence of osteoporosis is high in a cohort of 258 patients with moderate to severe cGVHD due to prolonged exposure to risk factors for osteoporosis after allogeneic hematopoietic stem cell transplantation. We defined osteoporosis using BMD criteria (T-score ≤ -2.5) at three anatomical sites (femoral neck – FN, lumbar spine – LS, total hip – TH) and characterized risk factors through univariate and multivariate analyses. We found that low body weight (FN p<0.0001, LS p=0.0002, TH p<0.0001), malnutrition (FN p=0.0002, LS p=0.03, TH p=0.0076), higher platelet count (FN p=0.0065, TH p=0.0025), higher average NIH organ score (FN p=0.038), higher prednisone dose (LS p=0.032), lower complement component 3 (LS p=0.0073), and physical inactivity (FN p=0.01) were associated with osteoporosis in one or more site. T-scores were significantly lower in the FN than in the other two sites (p<0.0001 for both). The prevalence of osteoporosis and osteopenia was high (17% and 60%, respectively), supporting current recommendations for frequent monitoring of BMD. The association of higher platelet count in cGVHD patients with osteoporosis has not been previously reported and presents a new area of interest in the study of osteoporosis after allogeneic hematopoietic stem cell transplantation.

AimTo identify the factors associated with vitamin D status in patients with chronic graft-vs-host disease (cGVHD) and evaluate the association between serum vitamin D (25(OH)D) levels and cGVHD characteristics and clinical outcomes defined by the National Institutes of Health (NIH) criteria.Methods310 cGVHD patients enrolled in the NIH cGVHD natural history study (clinicaltrials.gov: NCT00092235) were analyzed. Univariate analysis and multiple logistic regression were used to determine the associations between various parameters and 25(OH)D levels, dichotomized into categorical variables: ≤20 and >20 ng/mL, and as a continuous parameter. Multiple logistic regression was used to develop a predictive model for low vitamin D. Survival analysis and association between cGVHD outcomes and 25(OH)D as a continuous as well as categorical variable: ≤20 and >20 ng/mL; <50 and ≥50 ng/mL, and among three ordered categories: ≤20, 20-50, and ≥50 ng/mL, was performed.

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and the cumulative-incidence function method to assess the association with neutrophil engraftment, acute and chronic graft-versus-host disease, TRM, and relapse. Patient, disease, and HCT-related characteristics were compared by chi-square statistic for categorical variables and the Kruskal-Wallis test for continuous variables. Results: Increased expression of the CTRA gene profile is associated with increased relapse at 3 years post-HCT (p¼.04; Figure 1) and decreased LFS overall (p¼.04; Figure 2). There were no significant outcome differences based on SES in this sample. HCT recipients of high SES lived closer to the transplant center (p<.001) while recipients with higher CTRA gene expression profiles were younger (p¼.04) and were infused with lower doses of peripheral blood cells (p.02). All other patient, disease, and demographic variables were equal between groups. Conclusions: Exposure to socioeconomic adversity is associated with a marked pro-inflammatory/anti-antiviral shift in the PBMC transcriptome and this shift in gene expression is reciprocally related to adverse clinical outcomes including increased relapse and decreased LFS.