Outcome of gastrointestinal graft-versus-host disease according to the treatment response.

Abstract

The optimal treatment strategy for gastrointestinal graft-versus-host disease (GI-GVHD) after allogeneic hematopoietic cell transplantation remains to be established. We retrospectively analyzed 68 cases of GI-GVHD at our institution between 2007 and 2017. The survival outcomes were significantly inferior in patients who did not respond to the first-line treatment (1-year overall survival 27.3 vs 69.2%, P = 0.0017; non-relapse mortality 50.0 vs 18.6%, P = 0.026). After subsequent treatments, 18 patients were refractory to all steroid-based treatments such as steroid pulse therapy and oral beclomethasone dipropionate (BDP). However, these steroid-refractory cases showed a gradual increase in the response rate after the initial diagnosis of steroid refractoriness. This result may be explained by the problem of evaluating the response based solely on the volume of diarrhea, i.e., severe mucosal damage due to refractory GI-GVHD may require a long recovery and sometimes be complicated with other diseases. In conclusion, patients with GI-GVHD who failed to respond to the first-line treatment had inferior survival. However, later improvement may be observed without additional immunosuppressant other than steroid among patients who initially do not respond to steroid therapy. It is important to repeat colonoscopy in patients with refractory GI-GVHD to monitor the activity of GVHD.

• Authors: Masaharu Tamaki, Hideki Nakasone, Yukiko Misaki, Kazuki Yoshimura, Ayumi Gomyo, Jin Hayakawa, Machiko Kusuda, Yu Akahoshi, Yuko Ishihara, Koji Kawamura, Aki Tanihara, Miki Sato, Kiriko Terasako-Saito, Kazuaki Kameda, Hidenori Wada, Misato Kikuchi, Shun-Ichi Kimura, Shinichi Kako, Yoshinobu Kanda
• Journal: Annals of hematology (Ann Hematol) Vol. 97 Issue 10 Pg. 1951-1960 (Oct 2018) ISSN: 1432-0584 [Electronic] Germany
• PMID: 29860563 (Publication Type: Journal Article)

Chemical References

• Adrenal Cortex Hormones
• Immunosuppressive Agents

Topics

• Adolescent
• Adrenal Cortex Hormones (therapeutic use)
• Adult
• Aged
• Allografts
• Diarrhea (drug therapy, etiology, immunology)
• Disease-Free Survival
• Drug Resistance
• Female
• Gastrointestinal Diseases (drug therapy, etiology, immunology, mortality)
• Graft vs Host Disease (drug therapy, etiology, mortality)
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Immunosuppressive Agents (therapeutic use)
• Infections (etiology, mortality)
• Kaplan-Meier Estimate
• Male
• Middle Aged
• Proportional Hazards Models
• Retrospective Studies
• Transplantation Conditioning (adverse effects)
• Young Adult