title: Gastrointestinal graft-versus-host disease in recipients of autologous hematopoietic stem cells: incidence, risk factors, and outcome.
abstract: Graft-versus-host disease (GVHD) is seen in skin, intestinal mucosa, and liver after autologous stem cell transplantation. We reviewed 681 consecutive patients to estimate the probability of gastrointestinal (GI) GVHD, response to treatment, risk factors for development, and effect on survival. GI GVHD was defined by persistent symptoms, mucosal abnormalities at endoscopy, and histology showing apoptotic crypt cells with or without lymphoid infiltrates. The proportion of patients with GI GVHD was 90/681 (13%). Nausea and vomiting occurred in 90% and diarrhea in 40%. The mean time to developing symptoms was day +15, that to histologically proven diagnosis was day +42, and that to starting prednisone treatment was day +45 after stem cell infusion. Treatment with a short course of prednisone effected durable responses in 79% of patients, and an additional 18% responded to a second course of prednisone. A multivariable logistic regression model demonstrated that the combined factor of a diagnosis of breast cancer or hematologic malignancy and female sex was statistically significantly associated with the probability of GI GVHD (P = .003). Survival in patients with GI GVHD was not statistically different than that in those without GVHD. We conclude that women with breast cancer or hematologic malignancy are more likely to develop GI GVHD after autologous transplantation, and that treatment with prednisone was effective.
authors.affiliation: Medical Oncology, Clinical Research Division, Fred Hutchinson Cancer Research Center and the University of Washington School of Medicine, Seattle, Washington 98109, USA.
authors.forename: Leona
authors.initials: L
authors.lastname: Holmberg
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Ted A
authors.initials: TA
authors.lastname: Gooley
authors.forename: Kristina M
authors.initials: KM
authors.lastname: Adams
authors.forename: David M
authors.initials: DM
authors.lastname: Hockenbery
authors.forename: Mary E D
authors.initials: ME
authors.lastname: Flowers
authors.forename: H Gary
authors.initials: HG
authors.lastname: Schoch
authors.forename: William
authors.initials: W
authors.lastname: Bensinger
authors.forename: George B
authors.initials: GB
authors.lastname: McDonald
mesh_terms: D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000401:mortality*; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000401:mortality*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D011241:Prednisone / Q000008:administration & dosage; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000401:mortality* / Q000628:therapy; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000893:Anti-Inflammatory Agents; D011241:Prednisone