Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation.
We hypothesized that clinical risk factors could be identified within 2 weeks of onset of severe (stage 3 or 4) acute gut GVHD for identifying a patient population with a very poor outcome. Among 1462 patients who had allogeneic hematopoietic cell transplantation (HCT) between January 2000 and December 2005, 116 (7.9%) developed stage 3-4 gut GVHD. The median time for onset of stage 3-4 gut GVHD was 35 (4-135) days after allogeneic HCT. Eighty-five of the 116 patients (73%) had corticosteroid resistance before or within 2 weeks after the onset of stage 3-4 gut GVHD. Significant risk factors for mortality included corticosteroid resistance (hazards ratio (HR)=2.93; P=0.0005), age >18 years (HR=4.95; P=0.0004), increased serum bilirubin (HR 2.53; P=0.0001) and overt gastrointestinal bleeding (HR 2.88; P=0.0004). Among patients with stage 3-4 gut GVHD, the subgroup with 0, 1 or 2 risk factors had a favorable prognosis, whereas the subgroup with 3 or 4 risk factors had a dismal prognosis. This information should be considered in designing future studies of severe gut GVHD and in counseling patients about prognosis.
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
C
C
Castilla-Llorente
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
P J
PJ
Martin
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
G B
GB
McDonald
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
B E
BE
Storer
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
F R
FR
Appelbaum
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
H J
HJ
Deeg
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
M
M
Mielcarek
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
H
H
Shulman
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
R
R
Storb
1] Fred Hutchinson Cancer Research Center, Seattle, WA, USA [2] University of Washington, Seattle, WA, USA.
R A
RA
Nash
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D005260:Female; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000276:immunology; D006086:Graft vs Host Disease / Q000209:etiology* / Q000628:therapy; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects / Q000379:methods; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D055815:Young Adult