Differences in Acute Graft-Versus-Host Disease (GVHD) Severity and Its Outcomes Between Black and White Patients

Carlos A.Ortega Rios, Muna Qayed, Aaron M. Etra, Ran Reshef, Richard Newcomb, Nicholas Yuhasz, Elizabeth O. Hexner, Paibel Aguayo-Hiraldo, Pietro Merli, William J. Hogan, Daniela Weber, Carrie L. Kitko, Francis Ayuk, Matthias Eder, Stephan A. Grupp, Sabrina Kraus, Karam Sandhu, Evelyn Ullrich, Ingrid Vasova, Matthias WölflJanna Baez, Rahnuma Beheshti, Gilbert Eng, Sigrun Gleich, Nikolaos Katsivelos, Steven Kowalyk, Ioannis Evangelos Louloudis, George Morales, Nikolaos Spyrou, Rachel Young, Ryotaro Nakamura, John E. Levine, James L.M. Ferrara, Yu Akahoshi

Research output: Contribution to journalArticlepeer-review

Abstract

Acute graft-versus-host disease (GVHD) is a significant complication following hematopoietic stem cell transplantation (HCT). Although recent advancements in GVHD prophylaxis have resulted in successful HCT across HLA barriers and expanded access to HCT for racial minorities, less is known about how race affects the severity and outcomes of acute GVHD. This study examines differences in the clinical course of acute GVHD and the prognostic value of GVHD biomarkers for Black and White recipients. We conducted a retrospective analysis of patients in the Mount Sinai Acute GVHD International Consortium (MAGIC) database who underwent HCT between 2014 and 2021 to describe the difference in clinical course of acute GVHD and significance of GVHD biomarkers between Black and White recipients. We used propensity score matching to generate a 1:3 matched cohort of 234 Black patients and 702 White patients with similar baseline characteristics. In the first year after HCT Black patients experienced a higher cumulative incidence of grade III-IV acute GVHD (17% versus 12%, P = 0.050), higher nonrelapse mortality (NRM; 18% versus 12%, P =.009), and lower overall survival that trended toward statistical significance (73% versus 79%, P =.071) compared to White patients. The difference in NRM in the first year was even greater among Black patients who developed GVHD than White patients (24% versus 14%, P =.041). The distribution of low, intermediate, and high MAGIC biomarker scores at the time of treatment was similar across racial groups (P =.847), however, Black patients with high biomarker scores experienced significantly worse NRM than White patients (71% versus 32%, P =.010). Our data indicate that Black patients are at a higher risk of NRM following HCT, primarily from a higher incidence of severe GVHD. Serum biomarkers at treatment initiation can stratify patients for risk of NRM across races, however Black patients with high biomarker scores had a significantly greater NRM risk. These results suggest a need for strategies that mitigate the higher risk for poor GVHD outcomes among Black patients.

Original languageEnglish
Pages (from-to)1061.e1-1061.e10
JournalTransplantation and Cellular Therapy
Volume30
Issue number11
DOIs
StatePublished - Nov 2024

Keywords

  • Acute GVHD
  • Biomarker
  • Race

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