A study of pediatric cancer survivors suggests that chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic cell transplant (HCT) is associated with nonmalignant late effects but not subsequent neoplasms.

On the other hand, subsequent neoplasms were linked to myeloablative total body irradiation. These results were recently reported in Transplantation and Cellular Therapy.

Researchers performed this retrospective study using data from the Center for International Blood and Marrow Transplant Research to characterize late effects in children with cGVHD. Included patients had a first allogeneic HCT with myeloablative conditioning between the years of 2000 and 2010 for a hematologic malignancy, and they had reached 2 or more years of disease-free survival after HCT.

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Cumulative incidences of first malignant and nonmalignant late effects in these survivors were evaluated, with analyses based on outcomes for patients with and without cGVHD. Risk factors for first late effects were also examined.

Among 1260 survivors included in this study, the 2-year incidence of cGVHD after HCT was 39%. The 10-year cumulative incidence of any late effect was estimated to be 43% for survivors with cGVHD, compared with 32% for survivors without cGVHD (P <.001).

A multivariate analysis suggested that cGVHD 2 years after HCT was associated with the presence of any late effect (hazard ratio [HR], 1.38; 95% CI, 1.13-1.68; P =.001). The presence of cGVHD 2 years after HCT was not associated with subsequent neoplasms (HR, 1.30; 95% CI, 0.73-2.31; P =.38) but was associated with nonmalignant late effects (HR, 1.37; 95% CI, 1.10-1.70; P =.006).

Severe cGVHD (HR, 2.25; 95% CI, 1.60-3.17; P <.0001) was associated with nonmalignant late effects, as was extensive-grade cGVHD (HR, 1.60; 95% CI, 1.23-2.08; P =.0005) and interrupted onset-type cGVHD (HR, 1.57; 95% CI, 1.21-2.05; P =.0008). The presence of both mucocutaneous and visceral involvement was also associated with nonmalignant late effects (HR, 1.59; 95% CI, 1.24-2.03; P =.0002).

Although cGVHD was not associated with subsequent neoplasms, total body irradiation was (HR, 16.59; 95% CI, 2.21-124.25; P =.006). Total body irradiation was also associated with nonmalignant late effects (HR, 1.80; 95% CI, 1.39-2.33; P <.0001).

“Future research should continue upon this work and re-evaluate the impact of cGVHD on late effects using the 2014 National Institutes of Health consensus criteria for cGVHD,” the researchers concluded in their report.

Disclosures: Some authors declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.


Lee CJ, Wang T, Chen K, et al. Association of chronic graft-versus-host disease with late effects following allogeneic hematopoietic cell transplantation for children with hematologic malignancy. Transplant Cell Ther. Published online July 18, 2022. doi:10.1016/j.jtct.2022.07.014

This article originally appeared on Oncology Nurse Advisor