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Graft-versus-host Disease

Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 49, pages 966–971 (2014)Cite this article

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Abstract

We hypothesized that clinical risk factors could be identified within 2 weeks of onset of severe (stage 3 or 4) acute gut GVHD for identifying a patient population with a very poor outcome. Among 1462 patients who had allogeneic hematopoietic cell transplantation (HCT) between January 2000 and December 2005, 116 (7.9%) developed stage 3–4 gut GVHD. The median time for onset of stage 3–4 gut GVHD was 35 (4–135) days after allogeneic HCT. Eighty-five of the 116 patients (73%) had corticosteroid resistance before or within 2 weeks after the onset of stage 3–4 gut GVHD. Significant risk factors for mortality included corticosteroid resistance (hazards ratio (HR)=2.93; P=0.0005), age >18 years (HR=4.95; P=0.0004), increased serum bilirubin (HR 2.53; P=0.0001) and overt gastrointestinal bleeding (HR 2.88; P=0.0004). Among patients with stage 3–4 gut GVHD, the subgroup with 0, 1 or 2 risk factors had a favorable prognosis, whereas the subgroup with 3 or 4 risk factors had a dismal prognosis. This information should be considered in designing future studies of severe gut GVHD and in counseling patients about prognosis.

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Acknowledgements

We thank Helen Crawford and Bonnie Larson for their excellent support in typing the manuscript. We are also very thankful for the excellent care provided to patients and families by the inpatient and outpatient physicians, nursing teams and support staff at the Fred Hutchinson Cancer Research Center and at the University of Washington Medical Center. This work was supported in part by National Institutes of Health Grants CA018029, HL036444, CA078902 and CA015704. The funding body played no part in the design of the study, collection and analysis of data, or the decision to publish. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or its subsidiary Institutes and Centers.

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Author notes

  1. C Castilla-Llorente

    Present address: Servicio de Hematologia y Oncologia Médica, Hospital Universitario Morales Meseguer, Avda. Marqués de los Velez sn, Murcia 30008, Spain.,

  2. R A Nash

    Present address: Colorado Blood Cancer Institute, Denver, CO, USA.,

Authors and Affiliations

  1. Fred Hutchinson Cancer Research Center, Seattle, WA, USA

    C Castilla-Llorente, P J Martin, G B McDonald, B E Storer, F R Appelbaum, H J Deeg, M Mielcarek, H Shulman, R Storb & R A Nash

  2. University of Washington, Seattle, WA, USA

    P J Martin, G B McDonald, B E Storer, F R Appelbaum, H J Deeg, M Mielcarek, H Shulman, R Storb & R A Nash

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Correspondence to C Castilla-Llorente.

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Castilla-Llorente, C., Martin, P., McDonald, G. et al. Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 49, 966–971 (2014). https://doi.org/10.1038/bmt.2014.69

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