Acute Gastrointestinal Graft-versus-Host Disease in Pediatric Patients: Serum Albumin on Day 5 from Initiation of Therapy Correlates with Nonrelapse Mortality and Overall Survival

作者：Goussetis Evgenios^*; Paisiou Anna; Kitra Vasiliki; Peristeri Ioulia; Vessalas George; Stefanaki Kaliopi; Panayotou Ioanna; Giamaiou Konstantina; Kontou Eleftheria; Kitzoni Margaret; Dimopoulou Maria N; Karkelis Savvas; Kafritsa Yota; Rapsomaniki Eleni; Papassotiriou Ioannis; Tsirigotis Panagiotis; Roma Eleftheria; Graphakos Stelios

来源：Biology of Blood and Marrow Transplantation, 2011, 17(7): 1058-1066.

DOI：10.1016/j.bbmt.2010.11.005

• Serum albumin
• Early predictor
• Gastrointestinal
• aGVHD

The aim of the present study was to identify factors associated with the risk of development of gastrointestinal acute graft-versus-host disease (GI-aGVHD), as well as to evaluate the impact of various baseline parameters on response to treatment, nonrelapse mortality (NRM), and overall survival (OS) in pediatric patients with Gl-aGVHD after allogeneic hematopoietic stem cell transplantation (allo-SCT). We retrospectively analyzed 300 pediatric patients who underwent allo-SCT from HLA-matched related or volunteer unrelated donors in our institution. GI tract involvement was observed in 46 out of 133 patients with aGVHD grade II-IV. Severe aGVHD (grade III-IV) was more frequently observed among patients with Gl-aGVHD in comparison with patients without GI involvement (P<.001). Treatment with steroids resulted in durable responses in 22/46 patients; 14 additional patients responded to salvage therapy, whereas 10 were refractory to all treatments administered. Using Cox regression analysis, we observed that serum albumin level >= 3 mg/dL on day 5 after the initiation of therapy with steroids was statistically significantly associated with decreased hazard of NRM and improved OS (P=.021 and P=.026, respectively). In our study, serum albumin level, early (+ day 5) after the onset of steroids in patients with Gl-aGVHD, was a predictor of treatment outcome. Prospective randomized trials need to be performed to verify the predictive significance of serum albumin and the need for early intensification of immunosuppressive treatment.

• 出版日期2011-7