Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
Division of Radiology, Jichi Medical University Saitama Medical Center, Saitama, Japan.
J Gastroenterol. 2022 Aug;57(8):571-580. doi: 10.1007/s00535-022-01881-9. Epub 2022 Jun 3.
Pancreatic atrophy after allogeneic hematopoietic cell transplantation (HCT) is one of the symptoms associated with chronic graft-versus-host disease (GVHD). Although pancreatic atrophy has been considered to cause exocrine insufficiency and weight loss, it is not yet clear what kinds of recipients can be expected to recover their body weight (BW) or pancreatic thickness. In addition, the effect of pancreatic atrophy on the prognosis has not been clarified.
We retrospectively analyzed 170 recipients who received allogeneic bone marrow transplantation or peripheral blood stem cell transplantation, and evaluated them using the CT scan images obtained closest to 1, 2, 3, and 4 years after HCT.
Fifty-five recipients (32.4%) demonstrated pancreatic atrophy, and 11 (20%) of them recovered their pancreatic thickness. While recipients without pancreatic atrophy gradually recovered their BW (P < 0.001), those with atrophy did not (P = 0.12). Moderate and severe chronic GVHD tended to be slightly more common in the atrophy group (47.3% vs 38.3%), whereas the pancreatic thickness tended to recover in these recipients (30.8% vs 10.3%). HCT from a female donor to a male recipient showed superior pancreatic recovery compared to other donor and recipient sex combinations. Pancreatic atrophy treated as a significantly associated with inferior survival (HR 4.91, P < 0.001) and an increased risk of non-relapse mortality (HR 8.75, P < 0.001).
These results suggest that it is important to monitor pancreatic thickness after HCT. Further prospective investigations are warranted to clarify the significance of pancreatic atrophy on clinical outcomes.
异基因造血细胞移植（HCT）后胰腺萎缩是慢性移植物抗宿主病（GVHD）相关症状之一。尽管胰腺萎缩被认为会导致外分泌功能不全和体重减轻，但尚不清楚哪些受者有望恢复体重（BW）或胰腺厚度。此外，胰腺萎缩对预后的影响尚不清楚。
我们回顾性分析了 170 例接受异基因骨髓移植或外周血干细胞移植的受者，并用 HCT 后 1、2、3 和 4 年最接近的 CT 扫描图像进行评估。
55 例（32.4%）受者出现胰腺萎缩，其中 11 例（20%）恢复了胰腺厚度。无胰腺萎缩的受者 BW 逐渐恢复（P<0.001），而有萎缩的受者则未恢复（P=0.12）。中度和重度慢性 GVHD 在萎缩组中略为常见（47.3% vs. 38.3%），而这些受者的胰腺厚度有恢复趋势（30.8% vs. 10.3%）。女性供者向男性受者的 HCT 显示出优于其他供者和受者性别组合的胰腺恢复。将胰腺萎缩视为显著相关因素，与较差的生存相关（HR 4.91，P<0.001），并增加非复发死亡率的风险（HR 8.75，P<0.001）。
这些结果表明，HCT 后监测胰腺厚度很重要。需要进一步的前瞻性研究来阐明胰腺萎缩对临床结局的意义。
