Details

Autor(en) / Beteiligte

• CASTILLA-LLORENTE, C
• MARTIN, P. J
• MCDONALD, G. B
• STORER, B. E
• APPELBAUM, F. R
• DEEG, H. J
• MIELCAREK, M
• SHULMAN, H
• STORB, R
• NASH, R. A

Titel

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

Ist Teil von

• Bone marrow transplantation (Basingstoke), 2014-07, Vol.49 (7), p.966-971

Ort / Verlag

Basingstoke: Nature Publishing Group

Erscheinungsjahr

2014

Link zum Volltext

Quelle

Open access e-journals list

Beschreibungen/Notizen

• 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.