BACKGROUND: The clinical prognosis of gastrointestinal (GI) graft-versus-host disease (GvHD) is based on either a clinical staging system or histological or endoscopic findings. How these different scores correlate with each other and which have the greater impact on transplantation outcomes is, however, not clear. METHODS: Clinical, pathological, and endoscopic findings of the upper GI tract on 201 patients who underwent allogeneic hematopoietic stem cell transplantation were reviewed. The association between clinical, histological, and endoscopy grading was assessed by Kendall correlation coefficient. The agreement between grading systems was evaluated by kappa statistics. Factors associated with survival or steroid resistance were analyzed by proportional hazard models. RESULTS: At disease onset, no strong association was found between pathological and clinical grade at disease onset (τ=0.034, P=0.6). In contrast, endoscopy score and clinical grades were strongly associated (τ=0.37, P<0.001). The Kappa concordance coefficient (0.20) between histological and endoscopy scores was poor. However, by multivariate analysis all three scores significantly predicted survival rates CONCLUSIONS: Clinical, histological, and endoscopic scores poorly correlated with each other when estimated at the GI-GvHD onset. However, all three severe initial scores independently predict poor outcome. Of interest, clinical and endoscopic scores predict resistance to steroids while pathological does not.
BACKGROUND: The clinical prognosis of gastrointestinal (GI) graft-versus-host disease (GvHD) is based on either a clinical staging system or histological or endoscopic findings. How these different scores correlate with each other and which have the greater impact on transplantation outcomes is, however, not clear. METHODS: Clinical, pathological, and endoscopic findings of the upper GI tract on 201 patients who underwent allogeneic hematopoietic stem cell transplantation were reviewed. The association between clinical, histological, and endoscopy grading was assessed by Kendall correlation coefficient. The agreement between grading systems was evaluated by kappa statistics. Factors associated with survival or steroid resistance were analyzed by proportional hazard models. RESULTS: At disease onset, no strong association was found between pathological and clinical grade at disease onset (τ=0.034, P=0.6). In contrast, endoscopy score and clinical grades were strongly associated (τ=0.37, P<0.001). The Kappa concordance coefficient (0.20) between histological and endoscopy scores was poor. However, by multivariate analysis all three scores significantly predicted survival rates CONCLUSIONS: Clinical, histological, and endoscopic scores poorly correlated with each other when estimated at the GI-GvHD onset. However, all three severe initial scores independently predict poor outcome. Of interest, clinical and endoscopic scores predict resistance to steroids while pathological does not.
Authors: Howard M Shulman; Diana M Cardona; Joel K Greenson; Sangeeta Hingorani; Thomas Horn; Elisabeth Huber; Andreas Kreft; Thomas Longerich; Thomas Morton; David Myerson; Victor G Prieto; Avi Rosenberg; Nathaniel Treister; Kay Washington; Mirjana Ziemer; Steven Z Pavletic; Stephanie J Lee; Mary E D Flowers; Kirk R Schultz; Madan Jagasia; Paul J Martin; Georgia B Vogelsang; David E Kleiner Journal: Biol Blood Marrow Transplant Date: 2015-01-29 Impact factor: 5.742
Authors: Andreas Kreft; Anja Mottok; Ildiko Mesteri; Diana M Cardona; Anne Janin; Anja A Kühl; Mindaugas Andrulis; Andrea Brunner; Howard M Shulman; Giovanni Negri; Alexandar Tzankov; Elisabeth Huber Journal: Virchows Arch Date: 2015-07-12 Impact factor: 4.064
Authors: George B McDonald; Laura Tabellini; Barry E Storer; Richard L Lawler; Paul J Martin; John A Hansen Journal: Blood Date: 2015-05-18 Impact factor: 22.113
Authors: Andrew C Harris; Rachel Young; Steven Devine; William J Hogan; Francis Ayuk; Udomsak Bunworasate; Chantiya Chanswangphuwana; Yvonne A Efebera; Ernst Holler; Mark Litzow; Rainer Ordemann; Muna Qayed; Anne S Renteria; Ran Reshef; Matthias Wölfl; Yi-Bin Chen; Steven Goldstein; Madan Jagasia; Franco Locatelli; Stephan Mielke; David Porter; Tal Schechter; Zhanna Shekhovtsova; James L M Ferrara; John E Levine Journal: Biol Blood Marrow Transplant Date: 2015-09-16 Impact factor: 5.742