Mehrdad Payandeh - Department of Hematology and Medical Oncology, Kermanshah University of Medical Sciences, Kermanshah, Iran

In the current investigation, the late acute and chronic graft-versus-hostdisease (GvHD) were characterized per the 2014 NIH criteria amongIranian patients. Based on the manifestations at the onset, approximately60% displayed late acute GvHD and 40% had chronic GvHD. Thecumulative incidences of the late acute and chronic GvHD were about20% and 17%, respectively. Gastrointestinal involvement with the lateacute GvHD appeared to be infrequent among Iranian patients. A directcomparison of data between Iranian and other ethnicities is needed toexamine ethnic differences. To characterize the incidences and outcomesof late acute (LA) and chronic GvHD in East Asians according to the 2014NIH criteria, we retrospectively analyzed 30 consecutive Iranian patientswho had a first allogeneic hematopoietic cell transplantation (HCT)at our center between 2014 and 2018. According to manifestationsat onset, 18 patients (60%) had LA GvHD and 12 (40%) had chronicGvHD. The cumulative incidences of LA and chronic GvHD were 20%and 17%, respectively, at 48 months after HCT. The involved sites at theonset of LA GvHD included the skin (71%), gut (13%), and liver (8%). Our findings revealed that, 48 months after the onset of LA GvHD, thecumulative incidences of relapse, non-relapse mortality, transition tochronic GvHD, and discontinued systemic treatment were 11%, 6%,22%, and 46%, respectively. Cox models showed that the prior acuteGvHD was associated with the non-relapse mortality. Further, the HCTfrom a female donor to a male patient, myeloablative conditioning, andlow Karnofsky Performance Status were associated with a longer durationof systemic treatment after LA GvHD. The most frequently involved sitesat the onset of chronic GvHD included the mouth, liver, skin, and eyes.Cox models demonstrated that the use of anti-thymocyte globulin inconditioning regimens was associated with a higher risk of discontinuedsystemic treatment after the onset of chronic GvHD. Our data showedthat, 48 months after the onset of chronic GvHD, the cumulativeincidences of relapse, non-relapse mortality, and discontinued systemictreatment were 16%, 11%, and 41%, respectively. These findings proposeseveral potential differences between Iranian patients and those of otherethnicities. It seems that a direct comparison is needed to formallyinvestigate the ethnic differences.

Chronic graft-versus-host disease; National Institutes of Health criteria; Iranian