ISSN 1866-8836
Клеточная терапия и трансплантация

PC-07. Achievement of organ-specific response depending on FEV1 values in patients with pulmonary chronic graft-versus-host disease

Vera A. Vasilyeva, Larisa A. Kuzmina, Mikhail Yu. Drokov, Mariya V. Dovydenko, Olga M. Koroleva, Olga S. Karavaeva, Darya S. Dubnyak, Ulyana V. Maslikova, Elena N. Parovichnikova

National Medical Research Center for Hematology, Moscow, Russia


Contact: Dr. Vera A.Vasilyeva, phone: +7 (916) 262-23-16, e-mail: vasilievaVA4@mail.ru

doi 10.18620/ctt-1866-8836-2023-12-3-1-176

Summary

Chronic graft-versus-host disease (cGvHD) is a frequent complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) which significantly reduces the overall survival and quality of life of patients. Chronic GvHD with lung involvement is one of the most severe manifestations of cGvHD. Our aim was to evaluate the dynamics of forced expiratory volume (FEV1) index in patients with cGvHD with lung involvement.

Materials and methods

We reviewed the results of 766 allo-HSCTs performed for 677 adult patients from January 2010 to December 2020. Pulmonary chronic GvHD was diagnosed in 50 patients. To define severity of cGvHD, we used the NIH scoring system (Jagasia et al., 2015). In most cases, a severe cGvHD was determined (40 cases), and a moderate degree was revealed in 10 patients. The clinical and HSCT characteristics are presented in Table 1.

Of the 50 patients, forty-three received systemic immunosuppressive therapy (IST) with glucocorticosteroids (GCS) +/- other immunosuppressive agents, five patients did not receive GCS therapy, two patients received GCS inhalations only.

Results

The overall response rate in patients with pulmonary cGvHD was 26% (10% reached a complete response). The majority of patients did not achieve a response, 30% of them showed stabilization of the condition, and 44% exhibited progression of the lung cGvHD. We analyzed the FEV1 values at the onset, 3 months, 6 months and a 1 year after the diagnosis of pulmonary cGvHD, as well as the dynamics of FEV1 (a difference between the FEV1 values at diagnosis of pulmonary cGvHD, and one year later). A significant difference was found: patients with progression of pulmonary cGvHD developed a sufficient reduction of FEV1, with median FEV1 values decreasing by 13% over the year (Table 2). Therefore, one may conclude that the clinical response may be suggested as early as at 3 months after cGvHD diagnosis (even within the same NIH score point). In cases of further FEV1 reduction by >10%, the patient would not respond to the therapy in future, thus requiring early correction of immunosuppressive treatment.

Conclusion

It has been shown that a rapid decrease in FEV1 in dynamics indicates a poor prognosis in patients with cGvHD with lung involvement. Therefore it is important to evaluate not only the current FEV1 value, but also to monitor the FEV1 dynamics.

Keywords

Сhronic graft-versus-host disease, lung involvement, FEV1.


Table 1. Clinical characteristics of the patients under study

Vasylieva-02-tab01.jpg

Table 2. Achievement of the organ-specific response depending on the FEV1 indexes

Vasylieva-02-tab02.jpg
Supplement 12-3
09/30/2023

Download PDF version

doi 10.18620/ctt-1866-8836-2023-12-3-1-176

Back to the list