@article{3111546,
    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",
    author = "Goussetis, E. and Paisiou, A. and Kitra, V. and Peristeri, I. and Vessalas, G. and Stefanaki, K. and Panayotou, I. and Giamaiou, K. and Kontou, E. and Kitzoni, M. and Dimopoulou, M.N. and Karkelis, S. and Kafritsa, Y. and Rapsomaniki, E. and Papassotiriou, I. and Tsirigotis, P. and Roma, E. and Graphakos, S.",
    journal = "Biology of Blood and Marrow Transplantation",
    year = "2011",
    volume = "17",
    number = "7",
    pages = "1058-1066",
    issn = "1083-8791, 1523-6536",
    doi = "10.1016/j.bbmt.2010.11.005",
    keywords = "busulfan;  calcineurin inhibitor;  cyclophosphamide;  cyclosporin A;  etoposide;  fludarabine;  infliximab;  melphalan;  methotrexate;  methylprednisolone;  mycophenolic acid 2 morpholinoethyl ester;  octreotide;  serum albumin;  steroid;  tacrolimus;  thymocyte antibody, acute graft versus host disease;  acute lymphoblastic leukemia;  adolescent;  adult;  albumin blood level;  allogeneic hematopoietic stem cell transplantation;  aplastic anemia;  article;  child;  controlled study;  disease severity;  Fanconi anemia;  female;  gastrointestinal acute graft versus host disease;  graft versus host reaction;  hemoglobinopathy;  HLA matching;  human;  infant;  major clinical study;  male;  mortality;  myeloid leukemia;  nonrelapse mortality;  organ donor;  overall survival;  preschool child;  proportional hazards model;  reduced intensity conditioning;  retrospective study;  school child;  treatment response;  whole body radiation, Acute Disease;  Adolescent;  Albuminuria;  Anemia, Aplastic;  Biological Markers;  Bone Marrow Transplantation;  Cause of Death;  Child;  Child, Preschool;  Diarrhea;  Female;  Gastrointestinal Diseases;  Graft vs Host Disease;  Humans;  Immunosuppressive Agents;  Infant;  Kaplan-Meier Estimate;  Male;  Methylprednisolone;  Neoplasms;  Peripheral Blood Stem Cell Transplantation;  Proportional Hazards Models;  Retrospective Studies;  Salvage Therapy;  Survival Analysis;  Transplantation Conditioning;  Transplantation, Homologous;  Treatment Outcome;  Young Adult",
    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. © 2011 American Society for Blood and Marrow Transplantation."
}