Analysis of Risk Factors for Gastrointestinal Acute Graft-versus-host Disease after Allogeneic Hematopoietic Stem Cell Transplantation
Objective To investigate the clinical features,associated risk factors,and prognosis of gastrointestinal acute graft-ver-sus-host disease(GI-GVHD)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods The clinical data of 201 patients who underwent allo-HSCT in Affiliated Hospital of Xuzhou Medical University from January 2017 to July 2020 were retro-spectively analyzed,and grouped according to the occurrence of GI-GVHD.The factors associated with the occurrence of GI-GVHD were evaluated by univariate Logistic regression analysis,and the independent risk factors of their onset were evaluated by multivariate Logistic regression analysis,and further analyzed the effects of GI-GVHD on survival and prognosis.Results GI-GVHD occurred in 36 cases(17.9％)of the 201 patients who received allo-HSCT,with a median time to occur of 34(9-88)days and a median survival time of 228(21-1759)days,with an overall survival rate of 36.1％.The overall survival(OS)was significantly lower in patients who developed GI-GVHD at follow-up(36.1％vs 75.0％)compared with those without GI-GVHD,and the difference was statistically significant(P=0.004).Patients with GI-GVHD were characterized by persistent nausea and vomiting,abdominal pain,diarrhea,and gastrointestinal bleeding,often accompanied by damage to target organs such as the skin and liver.The results of univariate Logistic re-gression analysis showed that donor-recipient gender relationship(P=0.012),graft type(P=0.054),human leukocyte antigen(HLA)locus discrepancy(P=0.015),use of carbapenem antibiotics during pretreatment(P=0.029),use of carbapenems for more than 7 days during pretreatment(P=0.007),and early bloodstream infection(BSI,P=0.023)were influential factors in the occurrence of GI-GV HD.The results of multivariate Logistic regression analysis showed that female donor to male recipients(P=0.009,OR=8.866),non-related incompatible grafts(P=0.043,OR=16.532),carbapenem use for more than 7 days during pretreatment(P=0.023,OR=0.079),and early BSI(P=0.008,OR=0.165)were independent risk factors for the occurrence of GI-GVHD.Recipi-ent age,disease type,presence of underlying disease,graft type,duration of transplantation,the addition of antithymocyte globulin(ATG)to the pretreatment regimen,GVHD prophylaxis regimen,number of mononuclear cells(MNC)and CD34+cells returned,gran-ulocyte and megakaryocyte lineage time to reconstitution,and the occurrence of other types of GVHD were not risk factors for the occur-rence of GI-GVHD.The results of survival analysis showed that OS in the GI-GVHD group was significantly lower than that in the non-GI-GVHD group(36.1％vs 75.0％),and the difference was statistically significant(P=0.004).Conclusion Female donor to male recipients,non-related incompatible grafts,carbapenem use for more than 7 days during pretreatment,and early BSI may be the major risk factors for GI-GVHD,and the survival rate of patients with GI-GVHD after transplantation will be reduced.
万方数据
维普
