Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation

C Castilla-Llorente, PJ Martin, GB McDonald… - Bone marrow …, 2014 - nature.com
C Castilla-Llorente, PJ Martin, GB McDonald, BE Storer, FR Appelbaum, HJ Deeg…
Bone marrow transplantation, 2014nature.com
We hypothesized that clinical risk factors could be identified within 2 weeks of onset of
severe (stage 3 or 4) acute gut GVHD for identifying a patient population with a very poor
outcome. Among 1462 patients who had allogeneic hematopoietic cell transplantation
(HCT) between January 2000 and December 2005, 116 (7.9%) developed stage 3–4 gut
GVHD. The median time for onset of stage 3–4 gut GVHD was 35 (4–135) days after
allogeneic HCT. Eighty-five of the 116 patients (73%) had corticosteroid resistance before or …
Abstract
We hypothesized that clinical risk factors could be identified within 2 weeks of onset of severe (stage 3 or 4) acute gut GVHD for identifying a patient population with a very poor outcome. Among 1462 patients who had allogeneic hematopoietic cell transplantation (HCT) between January 2000 and December 2005, 116 (7.9%) developed stage 3–4 gut GVHD. The median time for onset of stage 3–4 gut GVHD was 35 (4–135) days after allogeneic HCT. Eighty-five of the 116 patients (73%) had corticosteroid resistance before or within 2 weeks after the onset of stage 3–4 gut GVHD. Significant risk factors for mortality included corticosteroid resistance (hazards ratio (HR)= 2.93; P= 0.0005), age> 18 years (HR= 4.95; P= 0.0004), increased serum bilirubin (HR 2.53; P= 0.0001) and overt gastrointestinal bleeding (HR 2.88; P= 0.0004). Among patients with stage 3–4 gut GVHD, the subgroup with 0, 1 or 2 risk factors had a favorable prognosis, whereas the subgroup with 3 or 4 risk factors had a dismal prognosis. This information should be considered in designing future studies of severe gut GVHD and in counseling patients about prognosis.
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