Population-based real-world registry study to evaluate clinical outcomes of chronic graft-versus-host disease

PLoS One. 2023 Mar 9;18(3):e0282753. doi: 10.1371/journal.pone.0282753. eCollection 2023.


Introduction: Chronic graft-versus-host disease (cGVHD) is a serious immune-mediated complication after allogeneic haematopoietic stem cell transplantation (HSCT), but in patients with malignancy, cGVHD development is associated with superior survival. Lack of reliable biomarkers and clinical underreporting means there is insufficient understanding of cGVHD clinical outcomes and balance between cGVHD treatment and maintaining beneficial graft-versus-tumour effects.

Methods: We performed a Swedish population-wide registry study following patients who underwent allogeneic HSCT 2006-2015. cGVHD status was retrospectively classified using a real-world method based on the timing and extent of systemic immunosuppressive treatment.

Results: cGVHD incidence among patients surviving ≥6 months post-HSCT (n = 1246) was 71.9%, significantly higher than previously reported. 5-year overall survival in patients surviving ≥6 months post-HSCT was 67.7%, 63.3%, and 65.3%, in non-, mild, and moderate-severe cGVHD, respectively. Non-cGVHD patients had a mortality risk almost five-fold higher compared to moderate-severe cGVHD patients 12-months post-HSCT. Moderate-severe cGVHD patients had greater healthcare utilization compared with mild and non cGVHD patients.

Conclusion: cGVHD incidence was high among HSCT survivors. Non-cGVHD patients had higher mortality during the first 6 months of follow-up; however, moderate-severe cGVHD patients had more comorbidities and healthcare utilization. This study highlights the urgent need for new treatments and real-time methods to monitor effective immunosuppression after HSCT.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Bronchiolitis Obliterans Syndrome*
  • Chronic Disease
  • Graft vs Host Disease* / etiology
  • Hematologic Neoplasms* / pathology
  • Hematopoietic Stem Cell Transplantation* / adverse effects
  • Humans
  • Retrospective Studies

Grants and funding

This study was funded by Janssen Global Services. The source data were provided by the Swedish National Board of Health and Welfare and Sweden Statistics. Writing assistance was provided Christina Jones and Tina Jacob of Schain Research, and Jill See, Sue Neville and Ian Phillips of Parexel. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.