TY - JOUR
TI - 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
AU - Goussetis, E.
AU - Paisiou, A.
AU - Kitra, V.
AU - Peristeri, I.
AU - Vessalas, G.
AU - Stefanaki, K.
AU - Panayotou, I.
AU - Giamaiou, K.
AU - Kontou, E.
AU - Kitzoni, M.
AU - Dimopoulou, M.N.
AU - Karkelis, S.
AU - Kafritsa, Y.
AU - Rapsomaniki, E.
AU - Papassotiriou, I.
AU - Tsirigotis, P.
AU - Roma, E.
AU - Graphakos, S.
JO - Biology of Blood and Marrow Transplantation
PY - 2011
VL - 17
TODO - 7
SP - 1058-1066
PB - 
SN - 1083-8791, 1523-6536
TODO - 10.1016/j.bbmt.2010.11.005
TODO - 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
TODO - 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.
ER -