Wang Zhuo, Tao Fang, Tang Wei, Nie Ying-Ming, Yang Li, Chen Zhi, Teng Ju-Xian, Lu Wen-Jie, Qi Shan-Shan, Xiong Hao
Department of Hematology & Oncology, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430016, Hubei Province, China.
Department of Hematology & Oncology, Wuhan Children's Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan 430016, Hubei Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2022 Apr;30(2):600-606. doi: 10.19746/j.cnki.issn.1009-2137.2022.02.046.
To observe the clinical characteristics, treatment and prognosis of intestinal acute graft-versus-host disease (aGVHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in children and futher evaluate the occurring risk factors.
The clinical data of 136 patients undergoing allo-HSCT in Wuhan Children's Hospital Affiliated to Tongji Medical College from August 2016 to August 2020 were retrospectively analyzed, clinical characteristics of children with intestinal aGVHD were observed. The risk factors of intestinal aGVHD were assessed by logistic regression while cumulative survival were analyzed by Kaplan-Meier method.
Among 136 patients intestinal aGVHD occurred in 24 (17.6%) cases, with 4 cases of grade II, 20 cases of grade III-IV, and the median occurrence time was 28(10-63) days. The clinical manifestations were diarrhea with intermittent abdominal pain, 17 cases with nausea and vomiting, 11 cases with fresh bloody stool, and 8 cases with skin rash before intestinal aGVHD. The average time for treatment was 33(11-100) days. 18 cases received electronic colonoscopy and histopathology examination. 20 out of 24 cases achieved remission after treatment, and the total effective rate was 83.3%. Finally, 9 out of 24 cases died during the follow-up time. Survival analysis showed that the cumulative survival rate of patients with intestinal aGVHD (15/24, 62.5%) were significantly lower than those without intestinal aGVHD (101/112, 90.2%) (Log-rank test, P=0.001). Univariate analysis showed that recipient age, sex, primary disease, donor age, donor sex, donor-recipient blood type, conditioning regimen, prophylaxis of GVHD, dosage of ATG, engraft time of blood platelet and neutrophils, and number of MNC/CD34+ were not risk factors for intestinal aGVHD (P>0.05). Only the type of HSCT (χ2=16.020, P=0.001) and matched degree of HLA (χ2=15.502, P=0.001) had statistical significance with intestinal aGVHD (P<0.05). Multivariate analysis showed that only HLA-mismatched unrelated donor was the risk factor for intestinal aGVHD for children (P=0.014，OR=16，95%CI 1.735-147.543).
Intestinal aGVHD is a risk factor for cumulative survial of patients who received allo-HSCT in children and HLA-mismatched unrelated donor is its independent risk factor.
观察儿童异基因造血干细胞移植（allo-HSCT）后肠道急性移植物抗宿主病（aGVHD）的临床特征、治疗及预后，并进一步评估其发生的危险因素。
回顾性分析2016年8月至2020年8月在华中科技大学同济医学院附属武汉儿童医院接受allo-HSCT的136例患者的临床资料，观察肠道aGVHD患儿的临床特征。采用logistic回归评估肠道aGVHD的危险因素，采用Kaplan-Meier法分析累积生存率。
136例患者中，24例（17.6%）发生肠道aGVHD，其中Ⅱ级4例，Ⅲ-Ⅳ级20例，中位发生时间为28（10-63）天。临床表现为腹泻伴间歇性腹痛，17例伴有恶心呕吐，11例有鲜血便，8例在肠道aGVHD前有皮疹。平均治疗时间为33（11-100）天。18例接受电子结肠镜及组织病理学检查。24例中20例治疗后缓解，总有效率为83.3%。最终，24例中有9例在随访期间死亡。生存分析显示，肠道aGVHD患者的累积生存率（15/24，62.5%）显著低于无肠道aGVHD患者（101/112，90.2%）（Log-rank检验，P=0.001）。单因素分析显示，受者年龄、性别、原发病、供者年龄、供者性别、供受者血型、预处理方案、GVHD预防、ATG剂量、血小板及中性粒细胞植入时间、MNC/CD34+数量均不是肠道aGVHD的危险因素（P>0.05）。仅HSCT类型（χ2=16.020，P=0.001）和HLA配型程度（χ2=15.502, P=0.001）与肠道aGVHD有统计学意义（P<0.05）。多因素分析显示，仅HLA不相合非血缘供者是儿童肠道aGVHD的危险因素（P=0.014，OR=16，95%CI 1.735-147.543）。
肠道aGVHD是儿童接受allo-HSCT患者累积生存的危险因素，HLA不相合非血缘供者是其独立危险因素。
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