“Grade-1 Skin-only Acute-gvhd”: One Week After Rash Appearance as the Time Point to Decide on Treatment

Abstract After allogeneic hematopoietic transplantation, a limited skin a-GVHD (Grade 1 a-GVHD) is usually managed by topical treatment and the criteria to start systemic immunosuppressive therapy are not established. We performed a prospective observational study on 102 consecutive adult patients who underwent allogeneic HSC transplantation. Eighty-two presented a skin rash (80.3%) and thirty-one of them (37.8%) progressed to Grade 2- some within 48 hours (Group 1) while others within days 3–7 (Group 2). Fifty-one patients (62.2%) did not have progression to Grade 2 GVHD within 7 days (Group 3). These patients were followed up. The Group 3 patients were subdivided into Group 3A (these had a stable or fading rash from the day of appearance to day 8) and Group 3B (these had a worsening rash from appearance to day 8). In group 3A the clinical results were significantly superior compared to results obtained in group 3B patients. In Group 3A versus Group 3B, Overall Survival at 2 years was 75.1% vs 39.8% (p = 0.03), Treatment Related mortality was 10.4% vs 39.2% (p = 0.05), need for secondary anti-GVHD treatment was 46.6% vs 76.4% (p = 0.002). The dynamic of skin rash during the first week from appearance marks patients with different prognosis.