Acute Gastrointestinal Graft-versus-Host Disease in Pediatric Patients: Serum Albumin on Day 5 from Initiation of Therapy Correlates with Nonrelapse Mortality and Overall Survival

医学 内科学 胃肠病学 危险系数 造血干细胞移植 比例危险模型 白蛋白 疾病 移植 移植物抗宿主病 血清白蛋白 胃肠道 耐火材料(行星科学) 置信区间 天体生物学 物理
作者
Evgenios Goussetis,Anna Paisiou,Vasiliki Kitra,Ioulia Peristeri,George Vessalas,Kaliopi Stefanaki,Ioanna Panayotou,Konstantina Giamaiou,Eleftheria Kontou,Margaret Kitzoni,Maria Dimopoulou,Savvas Karkelis,Yota Kafritsa,Eleni Rapsomaniki,Ioannis Papassotiriou,Panagiotis Tsirigotis,Elefthería Roma,Stelios Graphakos
出处
期刊:Biology of Blood and Marrow Transplantation [Elsevier BV]
卷期号:17 (7): 1058-1066 被引量:12
标识
DOI:10.1016/j.bbmt.2010.11.005
摘要

The aim of the present study was to identify factors associated with the risk of development of gastrointestinal acute graft-versus-host disease (GI-aGVHD), as well as to evaluate the impact of various baseline parameters on response to treatment, nonrelapse mortality (NRM), and overall survival (OS) in pediatric patients with GI-aGVHD after allogeneic hematopoietic stem cell transplantation (allo-SCT). We retrospectively analyzed 300 pediatric patients who underwent allo-SCT from HLA-matched related or volunteer unrelated donors in our institution. GI tract involvement was observed in 46 out of 133 patients with aGVHD grade II-IV. Severe aGVHD (grade III-IV) was more frequently observed among patients with GI-aGVHD in comparison with patients without GI involvement (P < .001). Treatment with steroids resulted in durable responses in 22/46 patients; 14 additional patients responded to salvage therapy, whereas 10 were refractory to all treatments administered. Using Cox regression analysis, we observed that serum albumin level ≥ 3 mg/dL on day 5 after the initiation of therapy with steroids was statistically significantly associated with decreased hazard of NRM and improved OS (P = .021 and P = .026, respectively). In our study, serum albumin level, early (+ day 5) after the onset of steroids in patients with GI-aGVHD, was a predictor of treatment outcome. Prospective randomized trials need to be performed to verify the predictive significance of serum albumin and the need for early intensification of immunosuppressive treatment.
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