Outcome of gastrointestinal graft-versus-host disease according to the treatment response
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The optimal treatment strategy for gastrointestinal graft-versus-host disease (GI-GVHD) after allogeneic hematopoietic cell transplantation remains to be established. We retrospectively analyzed 68 cases of GI-GVHD at our institution between 2007 and 2017. The survival outcomes were significantly inferior in patients who did not respond to the first-line treatment (1-year overall survival 27.3 vs 69.2%, P = 0.0017; non-relapse mortality 50.0 vs 18.6%, P = 0.026). After subsequent treatments, 18 patients were refractory to all steroid-based treatments such as steroid pulse therapy and oral beclomethasone dipropionate (BDP). However, these steroid-refractory cases showed a gradual increase in the response rate after the initial diagnosis of steroid refractoriness. This result may be explained by the problem of evaluating the response based solely on the volume of diarrhea, i.e., severe mucosal damage due to refractory GI-GVHD may require a long recovery and sometimes be complicated with other diseases. In conclusion, patients with GI-GVHD who failed to respond to the first-line treatment had inferior survival. However, later improvement may be observed without additional immunosuppressant other than steroid among patients who initially do not respond to steroid therapy. It is important to repeat colonoscopy in patients with refractory GI-GVHD to monitor the activity of GVHD.
KeywordsGastrointestinal GVHD Steroid refractory Allogeneic transplantation Colonoscopy
M.T. and Y.K. conceived the original idea. M.T. and H.N. collected the data. M.T. and H.N. performed statistical analysis. M.T., H.N., and Y.K. analyzed results and interpreted the data. M.T. wrote the manuscript. The other authors contributed to critical revision of the manuscript. All authors approved the final version of the manuscript.
Compliance with ethical standards
This retrospective study was approved by the Institutional Review Board of Saitama Medical Center, Jichi Medical University, and performed in accordance with the Declaration of Helsinki and its later amendments.
Conflict of interest
The authors declare that they have no conflict of interest.
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