Patient Case Studies of GvHD

This is a video synopsis/summary of a Peer Exchange featuring Miguel-Angel Perales, MD; Nelli Bejanyan, MD; Amandeep Salhotra, MD; and Arpita Gandhi, MD, MS.

The panel discusses the challenge of relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT), which remains the leading cause of mortality in this setting. Regardless of the donor type, about 50% of patients who die after 100 days of allogeneic transplantation succumb to relapse. Prevention of relapse is crucial, as treatment options for post-transplant relapse are limited.

A Center for International Blood and Marrow Transplant Research study reported in 2015 showed that among 1800 patients who relapsed after allogeneic transplantation, only 30% achieved subsequent complete remission with chemotherapy, and these remissions were not durable. Patients who appeared to benefit in terms of survival were those who received a second allogeneic transplantation or donor lymphocyte infusion (DLI). However, only 17% of patients were candidates for a subsequent allogeneic transplantation.

The timing of relapse is a critical predictor of subsequent survival. Patients who relapse within the first 6 months have a 1-year survival of only 4%, while those who relapse after 2 or more years, particularly at 3 to 4 years, can be salvaged with subsequent cellular-based therapy, such as DLI or DLI followed by a second allogeneic transplantation, with 30% to 40% achieving long-term survival.

Video synopsis is AI-generated and reviewed by OncLive® editorial staff.