A systematic literature review of incidence, mortality, and relapse of patients diagnosed with chronic graft versus host disease

Csanádi, Marcell; Ágh, Tamás; Tordai, Attila; Webb, Thomas; Jeyakumaran, Dusha; Sengupta, Nishan; Schain, Frida; Mattsson, Jonas

doi:10.1080/17474086.2019.1605288

Cited by 19 publications

(11 citation statements)

References 89 publications

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“…Despite improved survival following HSCT in patients with cGVHD [12], there is high long-term sickness absence in these patients that persists for at least 10 years. An incidence model suggested that, with the steady growth in HSCTs performed in Europe, the number of patients with cGVHD will increase by approximately 7.5% in the next 5 years [7].…”

Section: Discussionmentioning

confidence: 99%

“…cGVHD is associated with a lower risk of relapse of haematological malignancy [10,11]. However, it is also associated with an increased risk for non-relapse-related mortality and inferior overall survival in patients with more severe disease [10,12,13]. Further, cGVHD adversely affects patients' health-related quality of life (QoL) and functional status, with disease severity and organ involvement being key risk factors for such outcomes [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

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Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease

Schain¹,

Batyrbekova

Liwing

et al. 2020

Eur J Health Econ

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Chronic graft versus host disease (cGVHD) is a debilitating and costly complication following haemopoietic stem cell transplantation (HSCT). This study describes the economic burden associated with cGVHD. Direct costs associated with specialised healthcare utilisation (inpatient admissions and outpatient visits), as well as indirect costs associated with sickness absence-associated productivity loss were estimated in patients who underwent allogeneic HSCT in Sweden between 2006 and 2015, linking population-based health and economic registers. To capture the period of chronic GVHD, patients were included who survived > 182 days post-HSCT (start of follow-up), and cGVHD was classified based on patient treatment records to correct for any diagnosis underreporting. Patients were classified as ‘non-cGVHD’ if they received no immunosuppressive treatment, ‘mild cGVHD’ if they received only systemic corticosteroid treatment or immunosuppressive treatment, or ‘moderate–severe cGVHD’ if they received extracorporeal photopheresis (ECP) only, corticosteroid treatment and immunosuppressive treatment, or systemic corticosteroid treatment and ECP treatments. Patients with moderate–severe cGVHD spent more time in healthcare, had higher healthcare resource costs and higher sickness absence-related productivity loss compared to patients with non- or mild cGVHD. The cumulative total costs during the first 3 years of follow-up were EUR 14,887,599, EUR 20,544,056, and EUR 47,811,835 for non-, mild, and moderate–severe groups, respectively. The long-term costs incurred with cGVHD following HSCT continue to be very high and significantly impacted by cGVHD severity. This study adds real-world health resource and economic insight relevant for policy-makers and healthcare providers when considering the clinical challenge of balancing immunosuppression to reduce cGVHD.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease

Schain¹,

Batyrbekova

Liwing

et al. 2020

Eur J Health Econ

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“…It can occur as a characteristic of cGvHD or as overlap syndrome of both aGvHD and cGvHD, with the latter being associated with a worse prognosis [ 5 ]. cGvHD, in its severe form, has a 2-year cumulative incidence that ranges from 8.3% to 27.6% [ 21 ]. It is a major cause of non-relapse mortality in patients surviving more than 2 years after allo-SCT.…”

Section: Introductionmentioning

confidence: 99%

Burden and Needs of Patients with Severe GvHD from the Supportive and Palliative Care Perspective—A Literature Review

Wenzel

Pralong

Scheid

et al. 2021

Cancers

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Graft-versus-host disease (GvHD) is a frequent, and often life-threatening, complication after an allogeneic, hematopoietic stem cell transplantation (allo-SCT). It can appear in an acute or a chronic form and presents different grades of severity. Particularly, the severe forms of GvHD are often responsible for a change of the curative intent for allo-SCT into a palliative goal of care. For this non-systematic review, we conducted a focused literature search in the MEDLINE database via PubMed to examine whether patients with severe forms of GvHD might have special needs and burdens from a supportive and palliative care perspective. To draw a comprehensive picture of this patient group, we included findings on quality of life (QoL) and physical symptoms and function as well as psychological and spiritual well-being. In most domains, patients with severe forms of GvHD showed greater impairment and a higher symptom burden compared to patients with milder forms of GvHD. However, we could not identify any studies that specifically investigated patients with severe forms of GvHD. Further research in this field is necessary to guarantee the highest standard of care for this very special patient group.

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Section: Introductionmentioning

confidence: 99%

“…Chronic graft‐versus‐host disease (cGVHD) remains a relevant cause of late morbidity and mortality after allogeneic hematopoietic cell transplantation (alloHCT) 1–3 . CGVHD involves inflammation, humoral and cell‐mediated immunity, and fibrosis resulting in a syndrome of variable clinical features 2–4 . Diagnosing and scoring the severity of cGVHD remains a challenge secondary to the limited understanding of the pathophysiology, coexistence of acute GVHD manifestations, and general lack of biomarkers for the assessment of disease activity 3,4 …”

Section: Introductionmentioning

confidence: 99%

Prolactin, a potential biomarker for chronic GVHD activity

Salas

Ezzat

Lam

et al. 2020

European J of Haematology

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Introduction The polypeptide prolactin (PRL) is a peptide hormone and a cytokine mostly secreted from the anterior pituitary gland. PRL is also synthesized in extra pituitary tissues including thymocytes and T lymphocytes. Considering the need for chronic GVHD (cGVHD) biomarkers, we explored the relationship between hyperprolactinemia and active cGVHD in a cohort of long‐term post‐alloHCT survivors. Methods Three‐hundred sixteen adults underwent alloHCT between 2010 and 2016, survived more than 1 year and were included. All patients underwent a regular annual assessment that includes a hormone profile with serum PRL levels. Results Overall, 236 (74.7%) patients had cGVHD, and in 199 (63%), the grade was moderate or severe. Sixty‐five (21%) recipients had active cGVHD at the time of the annual evaluation, and hyperprolactinemia was documented in 63 (19.9%) patients. Hyperprolactinemia correlated with cGVHD activity (Odds Ratio 6.9 (95% CI; 3.6‐13.1); P < .001) in the multivariate analysis. In conclusion, patients with hyperprolactinemia were 6.4 times more likely to have active cGVHD in comparison with those patients with normal levels of PRL (P < .001). Conclusion Prolactin may serve as a biomarker for cGVHD activity. Further studies are required to confirm these findings, and to explore if hyperprolactinemia has an impact on cGVHD severity and prognosis.

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A systematic literature review of incidence, mortality, and relapse of patients diagnosed with chronic graft versus host disease

Cited by 19 publications

References 89 publications

Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease

Real-world study of direct medical and indirect costs and time spent in healthcare in patients with chronic graft versus host disease

Burden and Needs of Patients with Severe GvHD from the Supportive and Palliative Care Perspective—A Literature Review

Prolactin, a potential biomarker for chronic GVHD activity

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