Chronic liver graft-versus-host disease in allogeneic hematopoietic stem cell transplantation recipients during tapering or after stopping calcineurin inhibitors.

Abstract

Chronic graft-versus-host disease (cGVHD) of the liver is often observed in allogeneic hematopoietic stem cell transplantation (allo-HSCT) during tapering or after stopping calcineurin inhibitors (CI). We conducted a retrospective analysis of 242 allo-HSCT recipients whose CI dose was reduced to less than 40 mg of cyclosporin A or 0.4 mg of tacrolimus to clarify the clinical characteristics of liver GVHD in patients on low-dose CI. Sixty patients (25%) developed clinically suspected liver cGVHD while on low-dose CI. Multivariate analysis showed that donor age ≥ 40 years [hazard ratio (HR) 2.20], myeloablative conditioning (HR 2.19), female donor to male recipient (HR 2.53) and recipient seropositivity for herpes simplex virus (HR 2.52) were significant risk factors for liver cGVHD during low-dose CI period. Peak aspartate aminotransferase and alanine aminotransferase levels were higher in patients with liver GVHD during low-dose CI period than in other periods. Twenty-seven patients were initially treated with resumption of CI or a CI dose increase and 21 responded. Among the 18 patients treated with corticosteroids, total bilirubin was a risk factor for failure of corticosteroid therapy. The results of this study clarified the clinical characteristics of liver GVHD in patients on low-dose CIs.

• Authors: Kazuki Yoshimura, Shun-Ichi Kimura, Masakatsu Kawamura, Shunto Kawamura, Junko Takeshita, Nozomu Yoshino, Yukiko Misaki, Ayumi Gomyo, Shimpei Matsumi, Yu Akahoshi, Masaharu Tamaki, Machiko Kusuda, Kazuaki Kameda, Hidenori Wada, Koji Kawamura, Miki Sato, Kiriko Terasako-Saito, Aki Tanihara, Hideki Nakasone, Shinichi Kako, Yoshinobu Kanda
• Journal: International journal of hematology (Int J Hematol) Vol. 114 Issue 6 Pg. 674-681 (Dec 2021) ISSN: 1865-3774 [Electronic] Japan
• PMID: 34378178 (Publication Type: Journal Article)
• Copyright: © 2021. Japanese Society of Hematology.

Chemical References

• Calcineurin Inhibitors

Topics

• Adolescent
• Adult
• Aged
• Calcineurin Inhibitors (administration & dosage)
• Chronic Disease
• Disease Management
• Disease Susceptibility
• Drug Tapering
• Female
• Graft vs Host Disease (diagnosis, etiology, therapy)
• Hematopoietic Stem Cell Transplantation (adverse effects, methods)
• Humans
• Liver Diseases (diagnosis, etiology, prevention & control, therapy)
• Male
• Middle Aged
• Retrospective Studies
• Risk Factors
• Transplant Recipients
• Transplantation, Homologous
• Treatment Outcome
• Young Adult