Outcomes and predictors of chronic graft-vs-host-disease in bone marrow transplant recipients.

Abstract

e18552 Background: Chronic graft-versus-host disease (GVHD) affects approximately 20-40% of transplant recipients. It is a complication mediated by allogeneic T and B cells from the graft, which attack the genetically distinct tissues of the host. Chronic GVHD can significantly impact the outcome in patients undergoing bone marrow transplant (BMT) in terms of overall survival (OS) and progression-free survival (PFS) by increasing the risk of infections, graft failure, and multi-organ dysfunction. This study aims to analyze the outcome and predictors of chronic GHVD in patients undergoing BMT. Methods: We used the National Inpatient Sample database from 2016 to 2020, along with ICD-10 codes, to conduct a retrospective analysis and identify patients aged 18 and older who underwent BMT. The study assessed the impact of chronic GVHD on mortality, morbidity, and resource utilization in BMT patients. A chi-square test was used to analyze predictors of GVHD in BMT patients. Multivariate analysis, adjusted for confounders, was conducted to calculate the odds ratios for outcomes in BMT patients with GVHD. All weighted analyses were carried out using STATA MP 17.0. Results: 243,684 patients who underwent BMT were identified. Of these, 10.64% developed chronic GVHD. The mean age of BMT patients with chronic GVHD was 53.3 years, compared to 58.45 years for those without chronic GVHD. 43% of BMT patients with chronic GVHD were female, and 74% were white, 7% were Black, and 10% were Hispanic (p<0.001). Multivariate analysis, after adjusting for confounders, showed increased odds of mortality (Odds Ratio [OR]: 1.70, 95% Confidence Interval [CI]: 1.50-1.91, p<0.001), sepsis (OR: 1.34, CI: 1.23-1.45, p<0.001), and total hospital charge (Beta coefficient: $55,396, CI: $43,562-$67,230, p<0.001) in BMT patients who developed chronic GVHD compared to those without. A chi-square test analyzed the predictors of developing chronic GVHD in BMT patients (Table 1). Conclusions: Chronic GVHD affects approximately 1 in 10 BMT patients, and significantly increases total hospital charge , risks of death and infections like sepsis. Patients with chronic GVHD tend to be slightly younger and vary by race and gender. These findings highlight the importance of identifying high-risk patients and improving preventive strategies as prevention of chronic GVHD has more success than treatment Advances in conditioning regimen and treatment have improved outcomes in recent years, but chronic GVHD remains a major contributor to transplant-related mortality. Chi-square analysis showing predictors of developing chronic GVHD in BMT hospitalizations. Predictors with GVHD(%) without GVHD (%) p-value Sepsis 16.53 13.22 <0.001 Alcohol use 7.1 1.1 0.01 Liver disease 4.22 3.43 0.007 Diabetes 26.71 22.14 <0.001 Malnutrition 4.72 2.39 <0.001