Clinical Analysis of Cutaneous Chronic Graft-Versus-Host Disease Post-Allogeneic Hematopoietic Stem Cell Transplantation in Childhood.
10.19746/j.cnki.issn.1009-2137.2025.05.033
- Author:
Yu-Xian WANG
1
;
Hao XIONG
1
;
Zhi CHEN
1
;
Li YANG
2
;
Fang TAO
1
;
Yu DU
1
;
Zhuo WANG
1
;
Ming SUN
2
;
Shan-Shan QI
2
;
Lin-Lin LUO
1
Author Information
1. Department of Hematology, Wuhan Children's Hospital, Wuhan 430016, Hubei Province, China.
2. Institute of Pediatric Hematology, Wuhan Children's Hospital, Wuhan 430016, Hubei Province, China.
- Publication Type:Journal Article
- Keywords:
allogeneic hematopoietic stem cell transplantation;
chronic graft-versus-host disease;
skin;
childhood
- MeSH:
Humans;
Graft vs Host Disease/etiology*;
Hematopoietic Stem Cell Transplantation/adverse effects*;
Retrospective Studies;
Risk Factors;
Female;
Child;
Skin Diseases/etiology*;
Chronic Disease;
Transplantation, Homologous;
Male;
Child, Preschool;
Adolescent
- From:
Journal of Experimental Hematology
2025;33(5):1461-1467
- CountryChina
- Language:Chinese
-
Abstract:
OBJECTIVE:To investigate the clinical features and risk factors associated with cutaneous chronic graft-versus-host disease (cGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children.
METHODS:A retrospective analysis was conducted on the clinical data of children who underwent allo-HSCT in the Wuhan Children's Hospital from August 1, 2016, to December 31, 2023, and were regularly followed up for 1 year or more. The differences in clinical features between children with and without cutaneous cGVHD were compared, and the risk factors affecting the occurrence of cutaneous cGVHD were analyzed.
RESULTS:During the study period, 296 children received allo-HSCT. Until December 31, 2024, follow-up showed that 20 children (6.8%) developed cutaneous cGVHD, which manifested as cutaneous lichenification, hyperpigmentation, keratosis pilaris, sclerotic changes, and hair or nail involvement. According to their skin lesion area and degree of grading, 5 cases were mild, 10 cases were moderate, and 5 cases were severe. Multivariate logistic regression analysis revealed that female donors and previous acute GVHD were risk factors for the development of cutaneous cGVHD after allo-HSCT. All 20 children were treated with glucocorticoid ± calcineurin inhibitors (tacrolimus/cyclosporine) as first-line therapeutic agents. Only 1 child improved after first-line treatment. The remaining 19 children treated with a second-line regimen of combination interventions based on individualized status, including 10 children who could not tolerate hormonotherapy or first-line treatment, and showed no significant improvement after 3 months, as well as 9 children with multi-organ cGVHD. After comprehensive second-line treatment, 17 children showed improvement in cutaneous symptoms. There were 3 deaths, including 1 due to primary disease recurrence and 2 due to pulmonary infections.
CONCLUSION:The skin is the first manifestation and most common organ involved in cGVHD in children. Cutaneous cGVHD severely affects the daily activities of transplanted children and requires prolonged immunosuppressive therapy, but has a favorable prognosis. First-line treatments for adults are not applicable to children who usually require a combination treatment with multiple drugs.
