Analysis of gastrointestinal and hepatic chronic grant-versus-host disease manifestations on major outcomes: A chronic grant-versus-host disease consortium study

Joseph Pidala, Xiaoyu Chai, Brenda F. Kurland, Yoshihiro Inamoto, Mary E D Flowers, Jeanne Palmer, Nandita D Khera, Madan Jagasia, Corey Cutler, Mukta Arora, Georgia Vogelsang, Stephanie J. Lee

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Although data support adverse prognosis of overlap subtype of chronic grant-versus-host disease (GVHD), the importance of site of gastrointestinal (GI) and type of hepatic involvement is not known. Using data from the Chronic GVHD Consortium observational cohort study (N = 567, total of 2115 visits), we examined whether the site of GI (esophageal, upper GI, or lower GI) and type of hepatic (bilirubin, alkaline phosphatase, alanine aminotransferase) involvement are associated with overall survival (OS) and nonrelapse mortality (NRM), symptoms, quality of life (QOL) and functional status measures. In multivariate analysis utilizing data from enrollment visits only, lower GI involvement (HR, 1.67; P = .05) and elevated bilirubin (HR, 2.46; P = .001) were associated with OS; both were also associated with NRM. In multivariable analysis using all visits (time-dependent covariates), GI score greater than zero (HR, 1.69; P = .02) and elevated bilirubin (HR, 3.73; P < .001) were associated with OS; results were similar for NRM. Any esophageal involvement and GI score greater than zero were associated with both symptoms and QOL, whereas elevated bilirubin was associated with QOL. We found no consistent evidence that upper GI involvement, alkaline phosphatase, alanine aminotransferase, or NIH liver score add prognostic value for survival, overall symptom burden, or QOL. These data support important differences in patient-reported outcomes according to GI and hepatic involvement among chronic GVHD-affected patients and identify those with elevated bilirubin or higher GI score at any time, or lower GI involvement at cohort enrollment, as patients at greater risk for mortality under current treatment approaches.

Original languageEnglish (US)
Pages (from-to)784-791
Number of pages8
JournalBiology of Blood and Marrow Transplantation
Volume19
Issue number5
DOIs
StatePublished - May 2013

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Organized Financing
Bilirubin
Quality of Life
Liver
Survival
Mortality
Alanine Transaminase
Alkaline Phosphatase
Observational Studies
Cohort Studies
Multivariate Analysis

Keywords

  • Chronic GVHD
  • Gastrointestinal
  • Hepatic

ASJC Scopus subject areas

  • Transplantation
  • Hematology

Cite this

Analysis of gastrointestinal and hepatic chronic grant-versus-host disease manifestations on major outcomes : A chronic grant-versus-host disease consortium study. / Pidala, Joseph; Chai, Xiaoyu; Kurland, Brenda F.; Inamoto, Yoshihiro; Flowers, Mary E D; Palmer, Jeanne; Khera, Nandita D; Jagasia, Madan; Cutler, Corey; Arora, Mukta; Vogelsang, Georgia; Lee, Stephanie J.

In: Biology of Blood and Marrow Transplantation, Vol. 19, No. 5, 05.2013, p. 784-791.

Research output: Contribution to journalArticle

Pidala, Joseph ; Chai, Xiaoyu ; Kurland, Brenda F. ; Inamoto, Yoshihiro ; Flowers, Mary E D ; Palmer, Jeanne ; Khera, Nandita D ; Jagasia, Madan ; Cutler, Corey ; Arora, Mukta ; Vogelsang, Georgia ; Lee, Stephanie J. / Analysis of gastrointestinal and hepatic chronic grant-versus-host disease manifestations on major outcomes : A chronic grant-versus-host disease consortium study. In: Biology of Blood and Marrow Transplantation. 2013 ; Vol. 19, No. 5. pp. 784-791.
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