Impact of stem cell source on secondary steroid for chronic GVHD after allogeneic hematopoietic cell transplantation.

Abstract

Inappropriate discontinuation of immunosuppressive drugs (ISD) following allogeneic hematopoietic cell transplantation (HCT) can lead to the development of chronic graft-versus-host disease (cGVHD) and necessitate the reintroduction of ISD. However, only a few studies have compared the discontinuation rates of secondary steroid for cGVHD between different stem cell sources. We retrospectively evaluated 191 patients who underwent HCT at our institution to determine the discontinuation rates of secondary steroids for cGVHD. 50 patients (26.7%) received secondary steroid for cGVHD. After additional steroid for cGVHD, the 2-year cumulative steroid discontinuation rates were 50.0%, 0%, 8.3%, 44.0%, and 40.0% for MSD, uPBSC, uBM, UCB, PTCy-haplo, respectively (P = 0.0313). Patients transplanted with uBM or uPBSC had significantly lower cumulative discontinuation rates of additional steroids for cGVHD compared to those transplanted with other stem cell sources (P < 0.001). Multivariate analysis indicated that the cumulative steroid discontinuation rate was significantly lower in uPBSC or uBM group compared to in MSD group (uPBSC, HR, 0.10; P = 0.024, uBM, HR, 0.13; P = 0.007). Therefore, careful steroid reduction or additional treatment for cGVHD is necessary in patients transplanted with uBM and uPBSC.