title: 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.
abstract: 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.
authors.affiliation: Stem Cell Transplant Unit, "Aghia Sophia" Children's Hospital, Athens, Greece. evgoussetis@gmail.com
authors.forename: Evgenios
authors.initials: E
authors.lastname: Goussetis
authors.forename: Anna
authors.initials: A
authors.lastname: Paisiou
authors.forename: Vasiliki
authors.initials: V
authors.lastname: Kitra
authors.forename: Ioulia
authors.initials: I
authors.lastname: Peristeri
authors.forename: George
authors.initials: G
authors.lastname: Vessalas
authors.forename: Kaliopi
authors.initials: K
authors.lastname: Stefanaki
authors.forename: Ioanna
authors.initials: I
authors.lastname: Panayotou
authors.forename: Konstantina
authors.initials: K
authors.lastname: Giamaiou
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Kontou
authors.forename: Margaret
authors.initials: M
authors.lastname: Kitzoni
authors.forename: Maria N
authors.initials: MN
authors.lastname: Dimopoulou
authors.forename: Savvas
authors.initials: S
authors.lastname: Karkelis
authors.forename: Yota
authors.initials: Y
authors.lastname: Kafritsa
authors.forename: Eleni
authors.initials: E
authors.lastname: Rapsomaniki
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papassotiriou
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsirigotis
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Roma
authors.forename: Stelios
authors.initials: S
authors.lastname: Graphakos
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000419:Albuminuria / Q000209:etiology* / Q000652:urine; D000741:Anemia, Aplastic / Q000601:surgery; D015415:Biomarkers; D016026:Bone Marrow Transplantation / Q000009:adverse effects; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003967:Diarrhea / Q000188:drug therapy / Q000209:etiology / Q000276:immunology / Q000517:prevention & control / Q000652:urine; D005260:Female; D005767:Gastrointestinal Diseases / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control / Q000652:urine; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000517:prevention & control / Q000652:urine; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007223:Infant; D053208:Kaplan-Meier Estimate; D008297:Male; D008775:Methylprednisolone / Q000008:administration & dosage / Q000627:therapeutic use; D009369:Neoplasms / Q000601:surgery; D036102:Peripheral Blood Stem Cell Transplantation / Q000009:adverse effects; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D016879:Salvage Therapy; D016019:Survival Analysis; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000009:adverse effects; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007166:Immunosuppressive Agents; D008775:Methylprednisolone