Document Detail

Evaluation of prognostic factors among patients with chronic graft-versus-host disease.
MedLine Citation:
PMID:  22371184     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Chronic graft-versus-host disease (cGVHD) is a major complication after allogeneic stem cell transplantation with an adverse effect on both mortality and morbidity. In 2005, the National Institute of Health proposed new criteria for diagnosis and classification of chronic graft-versus-host disease for clinical trials. New sub-categories were recognized such as late onset acute graft-versus-host disease and overlap syndrome.
DESIGN AND METHODS: We evaluated the prognostic impact of the new sub-categories as well as the clinical scoring system proposed by the National Institute of Health in a retrospective, multicenter study of 820 patients undergoing allogeneic stem cell transplantation between 2000 and 2006 at 3 different institutions. Patients were retrospectively categorized according to the National Institute of Health criteria from patients' medical histories.
RESULTS: As far as the new sub-categories are concerned, in univariate analysis diagnosis of overlap syndrome adversely affected the outcome. Also, the number of organs involved for a cut-off value of 4 significantly influenced both cGVHD related mortality and survival. In multivariate analysis, in addition to NIH score, platelet count and performance score at the time of cGVHD diagnosis, plus gut involvement, significantly influenced outcome. These 3 variables allowed us to develop a simple score system which identifies 4 subgroups of patients with 84%, 64%, 43% and 0% overall survival at five years after cGVHD diagnosis (score 0: HR=15.96 (95% CI: 6.85-37.17), P<0.001; score 1: HR=5.47 (95% CI: 2.6-11.5), P<0.001; score 2: HR=2.8 (95% CI: 1.32-5.93), P=0.007).
CONCLUSIONS: In summary, we have identified a powerful and simple tool to discriminate different subgroups of patients in terms of chronic graft-versus-host disease related mortality and survival.
Jose A Pérez-Simón; Gabriel Afram; Rodrigo Martino; Jose L Piñana; Teresa Caballero-Velazquez; Olle Ringden; David Valcarcel; Dolores Caballero; Mats Remberger; Yanira de Paz; Jordi Sierra; Jesús San Miguel; Hans Hagglund
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Publication Detail:
Type:  Journal Article; Multicenter Study     Date:  2012-02-27
Journal Detail:
Title:  Haematologica     Volume:  97     ISSN:  1592-8721     ISO Abbreviation:  Haematologica     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-08-02     Completed Date:  2012-12-12     Revised Date:  2013-06-26    
Medline Journal Info:
Nlm Unique ID:  0417435     Medline TA:  Haematologica     Country:  Italy    
Other Details:
Languages:  eng     Pagination:  1187-95     Citation Subset:  IM    
Servicio de Hematología, Hospital Universitario de Salamanca, IBSAL, IBMCC (USAL-CSIC), Salamanca, Spain.
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MeSH Terms
Child, Preschool
Chronic Disease
Graft vs Host Disease / epidemiology,  etiology,  mortality*
Hematopoietic Stem Cell Transplantation / adverse effects
Middle Aged
Retrospective Studies
Transplantation, Homologous
Young Adult

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