Impact of age on graft-versus-host disease and overall survival in pediatric hematopoietic cell transplant recipients

Advances in graft-versus-host disease (GVHD) prevention and treatment have resulted in expanded donor options and improvement in treatment-related mortality (TRM). This analysis aimed to compare the incidence of acute and chronic GVHD (aGVHD and cGVHD, respectively) in pediatric patients by recipient age and to evaluate the impact of GVHD on overall survival (OS) and TRM. We included 14 099 patients aged ≤21 years who received their first allogeneic hematopoietic cell transplantation from 2002 to 2020, categorizing recipient age as 0 to 2 years (infants/toddlers), 3 to 12 years (school-aged), and 13 to 21 years (adolescent/young adult). There was no difference in grade 2 to 4 and 3 to 4 aGVHD by day 100 among age groups, except among patients with nonmalignant disease (NMD), among whom there was a small increase in incidence of severe aGVHD in older patients. Incidence of moderate/severe cGVHD by 1 year was higher with age. A similar impact of age was observed after adjusting for patient, donor, and transplant characteristics. Risk of severe aGVHD was higher in older children with NMD. Severe aGVHD and moderate/severe cGVHD were independently associated with inferior OS. In patients with malignant disease, both severe aGVHD and moderate/severe cGVHD were associated with increased risk of TRM. In conclusion, risk of moderate/severe cGVHD increases with recipient age, and risk of severe aGVHD is increased among older patients with nonmalignant conditions. Despite the low overall incidence of aGVHD and cGVHD in children, both are associated with significantly worse survival. These data highlight the need to consider GVHD outcomes at time of consultation and for improved prevention and treatment approaches.

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Publication Details

Journal
Blood Advances
Published
2025-12-12
DOI
https://doi.org/10.1182/bloodadvances.2025017393
Citations
1
Primary Topic
Hematopoietic Stem Cell Transplantation
Type
article
Field-Weighted Citation Impact
1.77

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article

Impact of age on graft-versus-host disease and overall survival in pediatric hematopoietic cell transplant recipients

Tim Prestidge, Olle Ringdén, Najla El Jurdi, Kristen M. Williams et al.
1 citations
Blood Advances
Hematopoietic Stem Cell Transplantation
1.77
article

Impact of age on graft-versus-host disease and overall survival in pediatric hematopoietic cell transplant recipients

Tim Prestidge, Olle Ringdén, Najla El Jurdi, Kristen M. Williams, Margaret L. MacMillan, Stephanie J. Lee, Muna Qayed, Zachariah DeFilipp, Hasan Hashem, Michelle Long Schoettler, Neel S. Bhatt, Betty K. Hamilton, Roomi Nusrat, Hemalatha G. Rangarajan, Stephen R. Spellman, Akshay Sharma, Takuto Takahashi, Carrie L. Kitko, Ashley Gray, Miki Nishitani, Rudi-Ann Tamara Graham, Tao Wang, Jakob D. DeVos, Christine Duncan
article en
1 citations

Abstract

Advances in graft-versus-host disease (GVHD) prevention and treatment have resulted in expanded donor options and improvement in treatment-related mortality (TRM). This analysis aimed to compare the incidence of acute and chronic GVHD (aGVHD and cGVHD, respectively) in pediatric patients by recipient age and to evaluate the impact of GVHD on overall survival (OS) and TRM. We included 14 099 patients aged ≤21 years who received their first allogeneic hematopoietic cell transplantation from 2002 to 2020, categorizing recipient age as 0 to 2 years (infants/toddlers), 3 to 12 years (school-aged), and 13 to 21 years (adolescent/young adult). There was no difference in grade 2 to 4 and 3 to 4 aGVHD by day 100 among age groups, except among patients with nonmalignant disease (NMD), among whom there was a small increase in incidence of severe aGVHD in older patients. Incidence of moderate/severe cGVHD by 1 year was higher with age. A similar impact of age was observed after adjusting for patient, donor, and transplant characteristics. Risk of severe aGVHD was higher in older children with NMD. Severe aGVHD and moderate/severe cGVHD were independently associated with inferior OS. In patients with malignant disease, both severe aGVHD and moderate/severe cGVHD were associated with increased risk of TRM. In conclusion, risk of moderate/severe cGVHD increases with recipient age, and risk of severe aGVHD is increased among older patients with nonmalignant conditions. Despite the low overall incidence of aGVHD and cGVHD in children, both are associated with significantly worse survival. These data highlight the need to consider GVHD outcomes at time of consultation and for improved prevention and treatment approaches.

Blood AdvancesVol. 10(6)
Boston Children's Hospital (US), National Institutes of Health (US), St. Jude Children's Research Hospital (US), Nationwide Children's Hospital (US), Cleveland Clinic (US), National Marrow Donor Program (US), Children's Hospital of Los Angeles (US), Harvard University (US), Emory University (US), University of Washington (US), Medical College of Wisconsin (US), University of Michigan (US), King Hussein Cancer Center (JO), University of Minnesota System (US), Karolinska Institutet (SE), Massachusetts General Hospital (US), Fred Hutch Cancer Center (US), Michigan United (US), Aflac (United States) (US), Michigan Medicine (US), Dana-Farber Cancer Institute (US), University of Minnesota Medical Center (US), National Cancer Institute (US), Starship Children's Health (NZ), Children's Healthcare of Atlanta (US), Boston Children's Museum (US), Dana-Farber/Boston Children's Cancer and Blood Disorders Center (US), Vanderbilt University Medical Center (US), College of The Bahamas (BS)
U.S. Department of Health and Human Services, Gateway for Cancer Research, Amgen, Bristol-Myers Squibb, Pfizer, Astellas Pharma US, AstraZeneca, Sanofi, Gilead Sciences, Alexion Pharmaceuticals, HistoGenetics, Novartis Pharmaceuticals Corporation, CSL Behring, Actinium Pharmaceuticals, Vertex Pharmaceuticals, Jazz Pharmaceuticals, Mallinckrodt Pharmaceuticals, Atara Biotherapeutics, CareDx, bluebird bio, Adaptive Biotechnologies, BeiGene, Incyte, Syndax Pharmaceuticals, Omeros Corporation, Seagen, Kiadis Pharma, Astellas Pharma, Swedish Orphan Biovitrum, MorphoSys, Medac, National Institutes of Health, Health Resources and Services Administration, Takeda Oncology, Pharmacyclics, Legend Biotech, National Heart, Lung, and Blood Institute, Office of Naval Research, National Cancer Institute, National Institute of Allergy and Infectious Diseases, Moonshot Research and Development Program, Cancer Moonshot
Openalex Percentile: Top 10%
Hematopoietic Stem Cell Transplantation
1.77
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