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Ferrata Storti Foundation
Stem Cell Transplantation
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
Haematologica 2018 Volume 103(10):1708-1719
Sarah Nikiforow,1,2 Tao Wang,3 Michael Hemmer,3 Stephen Spellman,4 Görgün Akpek,5 Joseph H. Antin,1,2 Sung Won Choi,6 Yoshihiro Inamoto,7 Hanna J. Khoury,8 Margaret MacMillan,9 David I. Marks,10 Ken Meehan,11 Hideki Nakasone,12 Taiga Nishihori,13 Richard Olsson,14 Sophie Paczesny,15 Donna Przepiorka,16 Vijay Reddy,17 Ran Reshef,18 Hélène Schoemans,19 Ned Waller,8 Daniel Weisdorf,9 Baldeep Wirk,20 Mary Horowitz,3
Amin Alousi,21 Daniel Couriel,6 Joseph Pidala,13 Mukta Arora4,9
and Corey Cutler1,2 for the GV12-02 Writing Committee on behalf of the CIBMTR® Graft-versus-Host Disease Working Committee
1Division of Hematologic Malignancies, Dana-Farber Cancer Institute, Boston, MA, USA; 2Harvard Medical School, Boston, MA, USA; 3Center for International Blood and Marrow Transplant Research (CIBMTR), Medical College of Wisconsin, Milwaukee, WI, USA; 4CIBMTR, Minneapolis, MN, USA; 5Rush University Medical Center, Chicago, IL, USA; 6University of Michigan Comprehensive Cancer Center, Ann Arbor, MI, USA; 7National Cancer Hospital, Tokyo, Japan; 8Emory University School of Medicine, Atlanta, GA, USA; 9University of Minnesota, Minneapolis, MN, USA; 10United Bristol Health Care Trust, UK; 11Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; 12Stanford University School of Medicine, CA, USA; 13H Lee Moffitt Cancer Center, Tampa, FL, USA; 14Karolinska Institute, Huddinge, Sweden; 15Indiana University School of Medicine, Indianapolis, IN, USA; 16US Food and Drug Administration, Center for Drug Evaluation and Research, Silver Spring, MD, USA; 17University of Central Florida College of Medicine, Orlando, FL, USA; 18Columbia University Medical Center, New York, NY, USA; 19Katholieke Universiteit, Lueven, Belgium; 20University of Stony Brook, NY, USA and 21MD 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 immunosup- pression. 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 trans- plant 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 manifesta- tions of Grades I or II acute graft-versus-host disease. If upper gastroin- testinal symptoms were reclassified as Grade 0 or I, 425 of 2083
Correspondence:
sarah_nikiforow@dfci.harvard.edu
Received: October 13, 2017. Accepted: July 31, 2018. Pre-published: August 3, 2018.
doi:10.3324/haematol.2017.182550
Check the online version for the most updated information on this article, online supplements, and information on authorship & disclosures: www.haematologica.org/content/103/10/1708
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