Impact of Concurrent Graft-versus-Host Disease on Long-Term Survival in Critically Ill Patients Following Allogeneic Hematopoietic Stem Cell Transplantation for Hematological Malignancies.

Graft-versus-host disease (GVHD) is a common and potentially fatal complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The impact of GVHD on the long-term survival of critically ill patients after allo-HSCT for hematological malignancies is underestimated. In this study, we aimed to elucidate the impact of concurrent GVHD on the long-term survival of critically ill patients after transplantation for hematological malignancies. Between January 2010 and June 2025, all critically ill patients after transplantation for hematological malignancies were retrospectively identified and included in this cohort. A total of 726 critically ill patients were finally analyzed. In total, 198 (27.3%) patients with concurrent GVHD and 528 (72.7%) patients without concurrent GVHD were included in the cohort. The 12-month overall survival rate of the cohort was 27.7%, which was significantly lower in patients with concurrent GVHD than in those without concurrent GVHD (16.2% versus 32.8%, log rank P < .001). Multivariate analyses revealed that concurrent GVHD (P = .002, hazard ratio [HR] 1.342, 95% confidence interval [CI] 1.117 to 1.613), relapse of hematological malignancies (P = .015, HR 1.510, 95% CI 1.083 to 2.105), sinusoidal obstruction syndrome (P = .048, HR 1.632, 95% CI 1.004 to 2.651), and ≥2 organ failures in the intensive care unit (P < .001, HR 1.864, 95% CI 1.559 to 2.228) were independent risk factors for overall survival. In conclusion, for critically ill patients who underwent allo-HSCT for hematologic malignancies, concurrent GVHD significantly reduced long-term survival.