Format

Send to

Choose Destination
Haematologica. 2018 Oct;103(10):1708-1719. doi: 10.3324/haematol.2017.182550. Epub 2018 Aug 3.

Upper gastrointestinal acute graft-versus-host disease adds minimal prognostic value in isolation or with other graft-versus-host disease symptoms as currently diagnosed and treated.

Author information

1
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA sarah_nikiforow@dfci.harvard.edu.
2
Harvard Medical School, Boston, MA, USA.
3
Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA.
4
CIBMTR, Minneapolis, MN, USA.
5
Rush University Medical Center, Chicago, IL, USA.
6
Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA.
7
University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA.
8
National Cancer Hospital, Tokyo, Japan.
9
Emory University School of Medicine, Atlanta, GA, USA.
10
University of Minnesota, Minneapolis, MN, USA.
11
United Bristol Health Care Trust, UK.
12
Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA.
13
Stanford University School of Medicine, CA, USA.
14
H Lee Moffitt Cancer Center, Tampa, FL, USA.
15
Karolinska Institute, Huddinge, Sweden.
16
Indiana University School of Medicine, Indianapolis, IN, USA.
17
US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA.
18
University of Central Florida College of Medicine, Orlando, FL, USA.
19
Columbia University Medical Center, New York, NY, USA.
20
Katholieke Universiteit, Lueven, Belgium.
21
University of Stony Brook, NY, USA.
22
MD Anderson Cancer Research Center, Houston, TX, USA.

Abstract

Upper gastrointestinal acute graft-versus-host disease is reported in approximately 30% of hematopoietic stem cell transplant recipients developing acute graft-versus-host disease. Currently classified as Grade II in consensus criteria, upper gastrointestinal acute graft-versus-host disease is often treated with systemic immunosuppression. We reviewed the Center for International Blood and Marrow Transplant Research database to assess the prognostic implications of upper gastrointestinal acute graft-versus-host disease in isolation or with other acute graft-versus-host disease manifestations. 8567 adult recipients of myeloablative allogeneic hematopoietic stem cell transplant receiving T-cell replete grafts for acute leukemia, chronic myeloid leukemia or myelodysplastic syndrome between 2000 and 2012 were analyzed. 51% of transplants were from unrelated donors. Reported upper gastrointestinal acute graft-versus-host disease incidence was 12.1%; 2.7% of recipients had isolated upper gastrointestinal acute graft-versus-host disease, of whom 95% received systemic steroids. Patients with isolated upper gastrointestinal involvement had similar survival, disease-free survival, transplant-related mortality, and relapse as patients with Grades 0, I, or II acute graft-versus-host disease. Unrelated donor recipients with isolated upper gastrointestinal acute graft-versus-host disease had less subsequent chronic graft-versus-host disease than those with Grades I or II disease (P=0.016 and P=0.0004, respectively). Upper gastrointestinal involvement added no significant prognostic information when present in addition to other manifestations of Grades I or II acute graft-versus-host disease. If upper gastrointestinal symptoms were reclassified as Grade 0 or I, 425 of 2083 patients (20.4%) with Grade II disease would be downgraded, potentially impacting the interpretation of clinical trial outcomes. Defining upper gastrointestinal acute graft-versus-host disease as a Grade II entity, as it is currently diagnosed and treated, is not strongly supported by this analysis. The general approach to diagnosis, treatment and grading of upper gastrointestinal symptoms and their impact on subsequent acute graft-versus-host disease therapy warrants reevaluation.

PMID:
30076185
PMCID:
PMC6165812
DOI:
10.3324/haematol.2017.182550
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for HighWire Icon for PubMed Central
Loading ...
Support Center