title: Acute gut GVHD in children: does skin involvement matter?
abstract: Gut GVHD (G-GVHD) is frequently the most severe and difficult to treat compared with skin GVHD. It is unknown if skin involvement with G-GVHD has prognostic significance. To compare the prognosis of acute isolated G-GVHD vs acute gut and skin GVHD (GS-GVHD) in children following allo-SCT. Allo-SCT recipients from Jan 2000-Dec 2009 were included and patients who underwent endoscopy and gut biopsy for G-GVHD were identified. Four hundred and fifty children (0-18 years) underwent allo-SCT during the study period. Seventy-nine (17.5%) patients underwent endoscopy and biopsy. At least stage II was required for skin involvement. Forty nine patients had G-GVHD and 30 had combined, GS-GVHD. The majority of patients received CsA and MTX for GVHD prophylaxis. Sixty-seven percent of patients with GS-GVHD had grade III-IV while only 31% had grade III-IV in the G-GVHD group. Median follow-up was 6.3 years (range 3.6-11.9 years). Relapse rate was similar in both the groups. However, children with G-GVHD had a significantly higher risk of dying from GVHD related complications (37% vs 16%) resulting in superior survival for those with skin involvement (79% vs 49% P=0.02). Extension of G-GVHD to the skin may suggest a better outcome.
authors.affiliation: Division of Haematology/Oncology/BMT, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada. adam.gassas@sickkids.ca
authors.forename: A
authors.initials: A
authors.lastname: Gassas
authors.forename: L
authors.initials: L
authors.lastname: Sung
authors.forename: A
authors.initials: A
authors.lastname: Dupuis
authors.forename: T
authors.initials: T
authors.lastname: Schechter
authors.forename: M
authors.initials: M
authors.lastname: Egeler
authors.forename: M
authors.initials: M
authors.lastname: Ali
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D005260:Female; D041981:Gastrointestinal Tract / Q000473:pathology*; D006086:Graft vs Host Disease / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D012867:Skin / Q000473:pathology*; D012871:Skin Diseases / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology / Q000473:pathology; D016019:Survival Analysis