Abstract
Chronic graft-versus-host-disease (cGvHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Among various organ-specific cGvHD, the cGvHD of liver is less well-characterized. In this study, we applied the National Institutes of Health 2014 scoring criteria of cGvHD to analyze a retrospective cohort of 362 allo-HSCT recipients focusing on cGvHD of liver. The overall incidence of liver cGvHD with a score of 3 by 1.5 years post-transplant was 5.8% (21/362). Poor outcome, in terms of overall survival (OS), were observed in patients with scores of 3 liver cGvHD, comparing to those with scores less than 3 (hazard ratio [HR] 2.037, 95% confidence interval [CI] 1.123–3.696, P = 0.019). In multivariate analysis, male gender (HR 4.004, P = 0.042) and chronic hepatitis C virus (HCV) infection status (HR 19.087, P < 0.001) were statistically significant risk factors for scores of 3 liver cGvHD. Our results indicate that liver cGvHD with scores of 3 has a grave prognosis following allo-HSCT, and that HCV carrier status and male are risk factors. Early recognition of this devastating complication might help in prompt immunosuppressive therapy and reducing late poor outcome.
Highlights
Chronic graft-versus-host disease is a serious complication of allogeneic hematopoietic stem cell transplantation and its incidence rate ranges from 30% to 70% [1]
Among 58 patients with liver Chronic graft-versus-host disease (cGvHD), 21 cases had a score of 3 (Table 2), and 11 patients progressed from previous scores of 1 or 2
mismatched unrelated donor (MUD) umbilical cord blood (UCB) Haplo-identical Disease risk, no. (%) Low (EBMT score ≦2) Intermediate (EBMT score 3) High (EBMT score ≧ 4) Stem cell source, no.(%) Mobilized blood cells Donor-Recipient gender combination, no. (%) Female to male Others Conditioning Regimen, no. (%) Busulfan-based TBI-based (12Gy) Cyclophosphamide-based Others Intensity of conditioning regimen, no. (%) Myeloablative Reduced-intensity TBI dose in conditioning regimen, no. (%) ≦450 cGy ≧1200 cGy GvHD prophylaxis regimen, no. (%) CsA plus MTX Anti-thymocyte globulin (ATG) Patient with chronic GvHD, no. (%) Sites+ involved with chronic GvHD, no. (%) Skin Lung Liver score 1 score 2 score 3 Eye
Summary
Chronic graft-versus-host disease (cGvHD) is a serious complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT) and its incidence rate ranges from 30% to 70% [1]. Risks of liver chronic graft-versus-host-disease: A cohort study survival outcomes, the National Institutes of Health (NIH) Consensus Conference Working Group first proposed criteriafor the diagnosis and scoring of cGvHD in 2005, which were refined in 2014 [6, 7]. The revision included changes in the cGvHD scoring of the skin, lungs, and liver. Previous studies have validated the implications of NIH scores [1, 8], including for cGVHD of major organs, such as lung [9,10,11] and skin cGVHD [12,13,14,15]. We aimed to use the NIH 2014 scoring criteria to characterize cGvHD of liver from a retrospective cohort data and examine the risk factors for liver cGvHD and the impacts on survival outcome
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