Clinical severity scores in gastrointestinal graft-versus-host disease.
BACKGROUND
The clinical prognosis of gastrointestinal (GI) graft-versus-host disease (GvHD) is based on either a clinical staging system or histological or endoscopic findings. How these different scores correlate with each other and which have the greater impact on transplantation outcomes is, however, not clear.


METHODS
Clinical, pathological, and endoscopic findings of the upper GI tract on 201 patients who underwent allogeneic hematopoietic stem cell transplantation were reviewed. The association between clinical, histological, and endoscopy grading was assessed by Kendall correlation coefficient. The agreement between grading systems was evaluated by kappa statistics. Factors associated with survival or steroid resistance were analyzed by proportional hazard models.


RESULTS
At disease onset, no strong association was found between pathological and clinical grade at disease onset (τ=0.034, P=0.6). In contrast, endoscopy score and clinical grades were strongly associated (τ=0.37, P<0.001). The Kappa concordance coefficient (0.20) between histological and endoscopy scores was poor. However, by multivariate analysis all three scores significantly predicted survival rates


CONCLUSIONS
Clinical, histological, and endoscopic scores poorly correlated with each other when estimated at the GI-GvHD onset. However, all three severe initial scores independently predict poor outcome. Of interest, clinical and endoscopic scores predict resistance to steroids while pathological does not.
1 AP-HP Hospital Saint Louis, Hematology/Transplantation, Paris, France. 2 AP-HP Hospital Saint Louis, Pathology, Paris, France. 3 Inserm U 728, Paris, France. 4 AP-HP Hospital Saint Louis, Gastroenterology, Paris, France. 5 AP-HP Hospital Saint Louis, DBIM, Paris, France. 6 Inserm U 940, Paris, France. 7 Address correspondence to: Gérard Socie, M.D., Ph.D., Hematology Transplantation, Hospital Saint Louis; 1 avenue Claude Vellefaux; 75475, Paris Cedex 10, France.
Julie
J
Abraham
Anne
A
Janin
Jean-Marc
JM
Gornet
Régis
R
Peffault de Latour
Marie
M
Robin
Aliénor
A
Xhaard
Flore Sicre
FS
de Fontebrune
Jean Yves
JY
Mary
Matthieu
M
Allez
Raphael
R
Porcher
Gérard
G
Socié
D000293:Adolescent; D000328:Adult; D000368:Aged; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D004351:Drug Resistance; D004724:Endoscopy; D005260:Female; D005767:Gastrointestinal Diseases / Q000175:diagnosis* / Q000401:mortality; D006086:Graft vs Host Disease / Q000175:diagnosis*; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D013256:Steroids / Q000494:pharmacology; D016896:Treatment Outcome; D055815:Young Adult
D013256:Steroids