{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T16:24:00Z","timestamp":1790267040469,"version":"4.1.0"},"reference-count":32,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T00:00:00Z","timestamp":1678320000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Janssen Global Services"},{"name":"Janssen Global Services"},{"name":"SDS Life Science"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Chronic graft-versus-host disease (cGVHD) is a serious immune-mediated complication after allogeneic haematopoietic stem cell transplantation (HSCT), but in patients with malignancy, cGVHD development is associated with superior survival. Lack of reliable biomarkers and clinical underreporting means there is insufficient understanding of cGVHD clinical outcomes and balance between cGVHD treatment and maintaining beneficial graft-versus-tumour effects.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>We performed a Swedish population-wide registry study following patients who underwent allogeneic HSCT 2006\u20132015. cGVHD status was retrospectively classified using a real-world method based on the timing and extent of systemic immunosuppressive treatment.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>cGVHD incidence among patients surviving \u22656 months post-HSCT (n = 1246) was 71.9%, significantly higher than previously reported. 5-year overall survival in patients surviving \u22656 months post-HSCT was 67.7%, 63.3%, and 65.3%, in non-, mild, and moderate-severe cGVHD, respectively. Non-cGVHD patients had a mortality risk almost five-fold higher compared to moderate-severe cGVHD patients 12-months post-HSCT. Moderate-severe cGVHD patients had greater healthcare utilization compared with mild and non cGVHD patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusion<\/jats:title>\n<jats:p>cGVHD incidence was high among HSCT survivors. Non-cGVHD patients had higher mortality during the first 6 months of follow-up; however, moderate-severe cGVHD patients had more comorbidities and healthcare utilization. This study highlights the urgent need for new treatments and real-time methods to monitor effective immunosuppression after HSCT.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0282753","type":"journal-article","created":{"date-parts":[[2023,3,9]],"date-time":"2023-03-09T18:26:24Z","timestamp":1678386384000},"page":"e0282753","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":9,"title":["Population-based real-world registry study to evaluate clinical outcomes of chronic graft-versus-host disease"],"prefix":"10.1371","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3748-3117","authenticated-orcid":true,"given":"Igor","family":"Novitzky-Basso","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frida","family":"Schain","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nurgul","family":"Batyrbekova","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Webb","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mats","family":"Remberger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Armand","family":"Keating","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2163-6644","authenticated-orcid":true,"given":"Jonas","family":"Mattsson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2023,3,9]]},"reference":[{"issue":"3","key":"pone.0282753.ref001","doi-asserted-by":"crossref","first-page":"374","DOI":"10.1182\/blood-2014-01-514752","article-title":"Current issues in chronic graft-versus-host disease","volume":"124","author":"G Socie","year":"2014","journal-title":"Blood"},{"issue":"5","key":"pone.0282753.ref002","doi-asserted-by":"crossref","first-page":"295","DOI":"10.1080\/17474086.2019.1602036","article-title":"Humanistic burden of patients with chronic graft-versus-host disease - systematic literature review of health-related quality of life and functional status","volume":"12","author":"T Agh","year":"2019","journal-title":"Expert Rev Hematol"},{"issue":"7","key":"pone.0282753.ref003","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1016\/j.bbmt.2012.01.010","article-title":"Graft-versus-tumor effect according to type of graft-versus-host disease defined by National Institutes of Health consensus criteria and associated outcomes","volume":"18","author":"BS Cho","year":"2012","journal-title":"Biol Blood Marrow Transplant"},{"issue":"5","key":"pone.0282753.ref004","doi-asserted-by":"crossref","first-page":"1106","DOI":"10.3109\/10428194.2013.820285","article-title":"National Institutes of Health classification for chronic graft-versus-host disease predicts outcome of allo-hematopoietic stem cell transplant after fludarabine-busulfan-antithymocyte globulin conditioning regimen","volume":"55","author":"C Saillard","year":"2014","journal-title":"Leuk Lymphoma"},{"issue":"5","key":"pone.0282753.ref005","first-page":"921","article-title":"Graft-versus-leukemia effect in allogeneic marrow transplant recipients with acute leukemia is maintained using cyclosporin A combined with methotrexate as prophylaxis. Acute Leukemia Working Party of the European Group for Blood and Marrow Transplantation","volume":"18","author":"O Ringden","year":"1996","journal-title":"Bone Marrow Transplant"},{"issue":"2","key":"pone.0282753.ref006","doi-asserted-by":"crossref","first-page":"e157","DOI":"10.1016\/S2352-3026(19)30256-X","article-title":"Prophylaxis and management of graft versus host disease after stem-cell transplantation for haematological malignancies: updated consensus recommendations of the European Society for Blood and Marrow Transplantation","volume":"7","author":"O Penack","year":"2020","journal-title":"Lancet Haematol"},{"issue":"3","key":"pone.0282753.ref007","doi-asserted-by":"crossref","first-page":"360","DOI":"10.1182\/blood-2017-03-775767","article-title":"An endpoint associated with clinical benefit after initial treatment of chronic graft-versus-host disease","volume":"130","author":"PJ Martin","year":"2017","journal-title":"Blood"},{"issue":"12","key":"pone.0282753.ref008","doi-asserted-by":"crossref","first-page":"5511","DOI":"10.1182\/blood-2007-01-069757","article-title":"Proteomic patterns predict acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation","volume":"109","author":"EM Weissinger","year":"2007","journal-title":"Blood"},{"issue":"12","key":"pone.0282753.ref009","doi-asserted-by":"crossref","first-page":"945","DOI":"10.1016\/j.bbmt.2005.09.004","article-title":"National Institutes of Health Consensus Development Project on Criteria for Clinical Trials in Chronic Graft-versus-Host Disease: I. 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A single-center study","volume":"17","author":"M Remberger","year":"2011","journal-title":"Biol Blood Marrow Transplant"},{"issue":"1","key":"pone.0282753.ref020","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1377\/hlthaff.2011.0762","article-title":"Use of 13 disease registries in 5 countries demonstrates the potential to use outcome data to improve health care\u2019s value","volume":"31","author":"S Larsson","year":"2012","journal-title":"Health Aff (Millwood)"},{"issue":"11","key":"pone.0282753.ref021","doi-asserted-by":"crossref","first-page":"1518","DOI":"10.1038\/bmt.2016.159","article-title":"High incidence of severe chronic GvHD after HSCT with sibling donors. 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