title: Analysis of gastrointestinal and hepatic chronic graft-versus-host [corrected] disease manifestations on major outcomes: a chronic graft-versus-host [corrected] disease consortium study.
abstract: Although data support adverse prognosis of overlap subtype of chronic grant-versus-host disease (GVHD), the importance of site of gastrointestinal (GI) and type of hepatic involvement is not known. Using data from the Chronic GVHD Consortium observational cohort study (N = 567, total of 2115 visits), we examined whether the site of GI (esophageal, upper GI, or lower GI) and type of hepatic (bilirubin, alkaline phosphatase, alanine aminotransferase) involvement are associated with overall survival (OS) and nonrelapse mortality (NRM), symptoms, quality of life (QOL) and functional status measures. In multivariate analysis utilizing data from enrollment visits only, lower GI involvement (HR, 1.67; P = .05) and elevated bilirubin (HR, 2.46; P = .001) were associated with OS; both were also associated with NRM. In multivariable analysis using all visits (time-dependent covariates), GI score greater than zero (HR, 1.69; P = .02) and elevated bilirubin (HR, 3.73; P < .001) were associated with OS; results were similar for NRM. Any esophageal involvement and GI score greater than zero were associated with both symptoms and QOL, whereas elevated bilirubin was associated with QOL. We found no consistent evidence that upper GI involvement, alkaline phosphatase, alanine aminotransferase, or NIH liver score add prognostic value for survival, overall symptom burden, or QOL. These data support important differences in patient-reported outcomes according to GI and hepatic involvement among chronic GVHD-affected patients and identify those with elevated bilirubin or higher GI score at any time, or lower GI involvement at cohort enrollment, as patients at greater risk for mortality under current treatment approaches.
authors: H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida. joseph.pidala@moffitt.org
authors: Joseph
authors: J
authors: Pidala
authors: Xiaoyu
authors: X
authors: Chai
authors: Brenda F
authors: BF
authors: Kurland
authors: Yoshihiro
authors: Y
authors: Inamoto
authors: Mary E D
authors: ME
authors: Flowers
authors: Jeanne
authors: J
authors: Palmer
authors: Nandita
authors: N
authors: Khera
authors: Madan
authors: M
authors: Jagasia
authors: Corey
authors: C
authors: Cutler
authors: Mukta
authors: M
authors: Arora
authors: Georgia
authors: G
authors: Vogelsang
authors: Stephanie J
authors: SJ
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D002908:Chronic Disease; D015331:Cohort Studies; D005260:Female; D041981:Gastrointestinal Tract / Q000276:immunology / Q000503:physiopathology*; D006086:Graft vs Host Disease / Q000276:immunology / Q000503:physiopathology*; D006801:Humans; D008107:Liver Diseases / Q000276:immunology / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D055815:Young Adult
references: Haematologica. 2011 Oct;96(10):1528-35
references: 21685473
references: Blood. 2011 Oct 13;118(15):4242-9
references: 21791424
references: J Orthop Res. 1988;6(2):215-22
references: 3343627
references: Biol Blood Marrow Transplant. 2005 Dec;11(12):945-56
references: 16338616
references: Br J Haematol. 2003 Jan;120(2):281-8
references: 12542488
references: Arch Phys Med Rehabil. 1982 Dec;63(12):620-2
references: 7149948
references: Hematology Am Soc Hematol Educ Program. 2008;:134-41
references: 19074071
references: Br J Haematol. 2010 Feb;148(3):373-85
references: 19919651
references: Biol Blood Marrow Transplant. 2011 Aug;17(8):1114-20
references: 21664473
references: Blood. 2009 Jul 2;114(1):7-19
references: 19336756
references: Bone Marrow Transplant. 2009 Jan;43(2):149-53
references: 18794869
references: Biol Blood Marrow Transplant. 2006 Mar;12(3):252-66
references: 16503494
references: J Hand Surg Am. 1984 Mar;9(2):222-6
references: 6715829
references: Bone Marrow Transplant. 1997 Feb;19(4):357-68
references: 9051246
references: Blood. 2009 Jul 16;114(3):702-8
references: 19470693
references: Haematologica. 2012 Mar;97(3):451-8
references: 22058206
references: Blood. 1989 Sep;74(4):1428-35
references: 2670000
references: Blood. 2011 Apr 28;117(17):4651-7
references: 21355084
references: Biol Blood Marrow Transplant. 2002;8(8):444-52
references: 12234170
references: Blood. 2004 Dec 1;104(12):3501-6
references: 15292060
references: Biol Blood Marrow Transplant. 2010 Dec;16(12):1707-17
references: 20541028
references: Leukemia. 2009 Jan;23(1):78-84
references: 18830253
references: Med Care. 1993 Mar;31(3):247-63
references: 8450681
references: Blood. 2006 Oct 15;108(8):2867-73
references: 16788100
references: Blood. 2011 Jun 16;117(24):6714-20
references: 21493797
references: Haematologica. 2011 Nov;96(11):1678-84
references: 21791465
references: Biol Blood Marrow Transplant. 2003 Apr;9(4):215-33
references: 12720215
references: Biol Blood Marrow Transplant. 2007 Oct;13(10):1207-15
references: 17889358
references: J Hematother Stem Cell Res. 2003 Apr;12(2):237-42
references: 12804182