Prognostic factors and outcomes of severe gastrointestinal GVHD after allogeneic hematopoietic cell transplantation

Abstract

We hypothesized that clinical risk factors could be identified within 2 weeks of onset of severe (stage 3 or 4) acute gut GVHD for identifying a patient population with a very poor outcome. Among 1462 patients who had allogeneic hematopoietic cell transplantation (HCT) between January 2000 and December 2005, 116 (7.9%) developed stage 3-4 gut GVHD. The median time for onset of stage 3-4 gut GVHD was 35 (4-135) days after allogeneic HCT. Eighty-five of the 116 patients (73%) had corticosteroid resistance before or within 2 weeks after the onset of stage 3-4 gut GVHD. Significant risk factors for mortality included corticosteroid resistance (hazards ratio (HR)=2.93; P=0.0005), age >18 years (HR=4.95; P=0.0004), increased serum bilirubin (HR 2.53; P=0.0001) and overt gastrointestinal bleeding (HR 2.88; P=0.0004). Among patients with stage 3-4 gut GVHD, the subgroup with 0, 1 or 2 risk factors had a favorable prognosis, whereas the subgroup with 3 or 4 risk factors had a dismal prognosis. This information should be considered in designing future studies of severe gut GVHD and in counseling patients about prognosis.

Figure 1. Overall survival of patients with stage 3–4 gut GVHD according to the number of risk factors

The risk factors include: 1) serum bilirubin >3.0, 2) corticosteroid-resistance, 3) age >18 years at transplant and 4) gastrointestinal bleeding. Risk factors are based on events occurring within the first 14 days after onset of stage 3–4 gut GVHD. (0–1 risk factors: n=18; 2 risk factors: n=30; 3 risk factors: n=35; 4 risk factors: n=33).