Clinical Study of Intestinal Acute Graft-Versus-Host Disease after Allogeneic Hematopoietic Stem Cell Transplantation in Children.
10.19746/j.cnki.issn.1009-2137.2022.02.046
- Author:
Zhuo WANG
1
;
Fang TAO
1
;
Wei TANG
1
;
Ying-Ming NIE
1
;
Li YANG
1
;
Zhi CHEN
1
;
Ju-Xian TENG
1
;
Wen-Jie LU
1
;
Shan-Shan QI
1
;
Hao XIONG
2
Author Information
1. Department of Hematology & Oncology, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430016, Hubei Province, China.
2. Department of Hematology & Oncology, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430016, Hubei Province, China,E-mail:22587481@qq.com.
- Publication Type:Journal Article
- Keywords:
acute graft-versus-host disease;
allogeneic hematopoietic stem cell transplantation;
children;
intestinal
- MeSH:
Acute Disease;
Child;
Graft vs Host Disease/prevention & control*;
Hematopoietic Stem Cell Transplantation/adverse effects*;
Humans;
Retrospective Studies;
Risk Factors;
Tissue Donors
- From:
Journal of Experimental Hematology
2022;30(2):600-606
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To observe the clinical characteristics, treatment and prognosis of intestinal acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children and futher evaluate the occurring risk factors.
METHODS:The clinical data of 136 patients undergoing allo-HSCT in Wuhan Children's Hospital Affiliated to Tongji Medical College from August 2016 to August 2020 were retrospectively analyzed, clinical characteristics of children with intestinal aGVHD were observed. The risk factors of intestinal aGVHD were assessed by logistic regression while cumulative survival were analyzed by Kaplan-Meier method.
RESULTS:Among 136 patients intestinal aGVHD occurred in 24 (17.6%) cases, with 4 cases of grade II, 20 cases of grade III-IV, and the median occurrence time was 28(10-63) days. The clinical manifestations were diarrhea with intermittent abdominal pain, 17 cases with nausea and vomiting, 11 cases with fresh bloody stool, and 8 cases with skin rash before intestinal aGVHD. The average time for treatment was 33(11-100) days. 18 cases received electronic colonoscopy and histopathology examination. 20 out of 24 cases achieved remission after treatment, and the total effective rate was 83.3%. Finally, 9 out of 24 cases died during the follow-up time. Survival analysis showed that the cumulative survival rate of patients with intestinal aGVHD (15/24, 62.5%) were significantly lower than those without intestinal aGVHD (101/112, 90.2%) (Log-rank test, P=0.001). Univariate analysis showed that recipient age, sex, primary disease, donor age, donor sex, donor-recipient blood type, conditioning regimen, prophylaxis of GVHD, dosage of ATG, engraft time of blood platelet and neutrophils, and number of MNC/CD34+ were not risk factors for intestinal aGVHD (P>0.05). Only the type of HSCT (χ2=16.020, P=0.001) and matched degree of HLA (χ2=15.502, P=0.001) had statistical significance with intestinal aGVHD (P<0.05). Multivariate analysis showed that only HLA-mismatched unrelated donor was the risk factor for intestinal aGVHD for children (P=0.014，OR=16，95%CI 1.735-147.543).
CONCLUSION:Intestinal aGVHD is a risk factor for cumulative survial of patients who received allo-HSCT in children and HLA-mismatched unrelated donor is its independent risk factor.
