Improved survival after acute graft-versus-host disease diagnosis in the modern era

Acute graft vs. host disease remains a major threat to successful outcome after allogeneic hematopoietic cell transplantation. While improvements in treatment and supportive care have occurred, it is unknown whether these advances have resulted in improved outcome specifically among those diagnosed with acute graft vs. host disease. We examined outcome following diagnosis of grade II-IV acute graft vs. host disease according to time period, and examine effects according to original graft vs. host disease prophylaxis regimen and maximum overall grade of acute GVHD. Between 1999 and 2012, 2,905 patients with acute myeloid leukemia (56%), acute lymphoblastic leukemia (30%) or myelodysplastic syndromes (14%) received sibling (24%) or unrelated donor (76%) blood (66%) or marrow (34%) transplant and developed grades II-IV acute graft vs. host disease (n=497 for 1999-2001, n=962 for 2002-2005, n=1,446 for 2006-2010). Median follow-up was 144 (4-174), 97 (4-147) and 60 (8-99) months for 1999-2001, 2002-2005, and 2006-2010, respectively. Among the grade II-IV acute graft vs. host disease cohort, there was a decrease in the proportion of grades III-IV acute graft vs. host disease over time with 56%, 47% , and 37% for 1999-2001, 2002-2005, and 2006-2012, respectively (p