Τίτλος:
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
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
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.
Συγγραφείς:
Goussetis, E.
Paisiou, A.
Kitra, V.
Peristeri, I.
Vessalas, G.
Stefanaki, K.
Panayotou, I.
Giamaiou, K.
Kontou, E.
Kitzoni, M.
Dimopoulou, M.N.
Karkelis, S.
Kafritsa, Y.
Rapsomaniki, E.
Papassotiriou, I.
Tsirigotis, P.
Roma, E.
Graphakos, S.
Περιοδικό:
Biology of Blood and Marrow Transplantation
Λέξεις-κλειδιά:
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
DOI:
10.1016/j.bbmt.2010.11.005
