Acute gut GVHD in children: does skin involvement matter?

Area of Science:

• Hematology
• Immunology
• Pediatric Oncology

Background:

• Graft-versus-host disease (GVHD) is a major complication of allogeneic stem cell transplantation (allo-SCT).
• Gut GVHD (G-GVHD) is often more severe than skin GVHD.
• The prognostic significance of skin involvement in G-GVHD is not well understood.

Purpose of the Study:

• To compare the prognosis of acute isolated G-GVHD versus acute gut and skin GVHD (GS-GVHD) in pediatric allo-SCT recipients.
• To investigate the impact of skin involvement on G-GVHD outcomes.

Main Methods:

• Retrospective analysis of pediatric allo-SCT recipients from 2000-2009.
• Inclusion criteria: patients undergoing endoscopy and gut biopsy for G-GVHD.
• Comparison between isolated G-GVHD (n=49) and GS-GVHD (n=30) groups.

Main Results:

• Higher incidence of grade III-IV GVHD in the GS-GVHD group (67%) compared to the G-GVHD group (31%).
• Relapse rates were similar between the two groups.
• Children with isolated G-GVHD had a significantly higher risk of mortality from GVHD-related complications (37% vs 16%).
• Survival was superior in the GS-GVHD group (79%) compared to the G-GVHD group (49%, P=0.02).

Conclusions:

• Extension of G-GVHD to the skin in pediatric allo-SCT recipients is associated with a better outcome.
• Skin involvement in G-GVHD may indicate a more favorable prognosis despite potentially higher initial GVHD grades.