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Xue L, Song L, Yu X, Yang X, Xia F, Ding X, Huang C, Wu D, Miao L. Assessment of risk factors for acute graft- versus-host disease post-hematopoietic stem cell transplantation: a retrospective study based on a proportional odds model using a nonlinear mixed-effects model. Ther Adv Hematol 2023; 14:20406207231205406. [PMID: 37872970 PMCID: PMC10590544 DOI: 10.1177/20406207231205406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 09/12/2023] [Indexed: 10/25/2023] Open
Abstract
Background Acute graft-versus-host disease (aGVHD) is a major complication following hematopoietic stem cell transplantation (HSCT). Objective This study aimed to explore the risk factors for the incidence of aGVHD in patients post-HSCT. Design This was a retrospective study. Methods A total of 407 patients were enrolled. The patients' data were recorded from the medical records. The exposure of cyclosporine was estimated based on a population pharmacokinetics model. The occurrence of aGVHD was clinically graded and staged in severity from grades I to IV. A proportional odds model that estimated the cumulative probabilities of aGVHD was used to analyze the data using a nonlinear mixed-effects model. Then, the model parameters and plausibility were evaluated by bootstrap and visual predictive checks. Results The typical probabilities were 18.9% and 17.9% for grade II and grades III-IV, respectively. The incidence of grade II and grade III-IV aGVHD for human leukocyte antigen (HLA) haplo sibling donor patients was higher than that for HLA-matched donor patients. The incidence of grade II and grade III-IV aGVHD decreased with increasing early cyclosporine trough concentration; however, cyclosporine exposure was not associated with the incidence of aGVHD. Conclusion HLA matching and early cyclosporine trough concentration were important factors for the occurrence of aGVHD.
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Affiliation(s)
- Ling Xue
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Pharmacology, Faculty of Medicine, University of the Basque Country – (UPV/EHU), Leioa, Spain
| | - Lin Song
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
- College of Pharmaceutical Sciences, Soochow University, Suzhou, China
| | - Xun Yu
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiao Yang
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fan Xia
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaoliang Ding
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chenrong Huang
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Depei Wu
- National Clinical Research Center for Hematologic Diseases, Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, No. 188, Shizi Street, Suzhou 215006, China
| | - Liyan Miao
- Department of Pharmacy, The First Affiliated Hospital of Soochow University, No. 899, Pinghai Road, Suzhou 215006, China
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Feng H, Wang X, Zheng W, Liu S, Jiang H, Lin Y, Qiu H, Chan TF, Huang M, Li Y, Mo X, Li J. Initial dosage optimisation of cyclosporine in Chinese paediatric patients undergoing allogeneic haematopoietic stem cell transplantation based on population pharmacokinetics: a retrospective study. BMJ Paediatr Open 2023; 7:e002003. [PMID: 37643815 PMCID: PMC10465907 DOI: 10.1136/bmjpo-2023-002003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 07/13/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE Improved understanding of cyclosporine A (CsA) pharmacokinetics in children undergoing allogeneic haematopoietic stem cell transplantation (allo-HSCT) is crucial for effective prevention of acute graft-versus-host disease and medication safety. The aim of this study was to establish a population pharmacokinetic (Pop-PK) model that could be used for individualised therapy to paediatric patients undergoing allo-HSCT in China. DESIGN, SETTING AND PARTICIPANTS A retrospective analysis of 251 paediatric HSCT patients who received CsA intravenously in the early post transplantation period at Women and Children's Medical Center in Guangzhou was conducted. ANALYSIS MEASURES The model building dataset from 176 children was used to develop and analyse the CsA Pop-Pk model by using the nonlinear mixed effect model method. The basic information was collected by the electronic medical record system. Genotype was analysed by matrix-assisted time-of-flight mass spectrometry. The stability and predictability of the final model were verified internally, and a validation dataset of 75 children was used for external validation. Monte Carlo simulation is used to adjust and optimise the initial dose of CsA in paediatric allo-HSCT patients. RESULTS The typical values for clearance (CL) and volume of distribution ([Formula: see text]) were 14.47 L/hour and 2033.53 L, respectively. The body weight and haematocrit were identified as significant variables for V, while only body weight had an impact on CL. The simulation based on the final model suggests that paediatrics with HSCT required an appropriate intravenous dose of 5 mg/kg/day to reach the therapeutic trough concentration. CONCLUSIONS The CsA Pop-PK model established in this study can quantitatively describe the factors influencing pharmacokinetic parameters and precisely predict the intrinsic exposure to CsA in children. In addition, our dosage simulation results can provide evidence for the personalised medications TRIAL REGISTRATION NUMBER: ChiCTR2000040561.
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Affiliation(s)
- Huanwen Feng
- Institute of Clinical Pharmacology, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
| | - Xianggui Wang
- Institute of Clinical Pharmacology, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
| | - Wei Zheng
- Department of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Sha Liu
- Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Hua Jiang
- Department of Hematology/Oncology, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Yuxian Lin
- Department of Pharmacy, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Haojie Qiu
- Department of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Teng Fong Chan
- Institute of Clinical Pharmacology, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
| | - Min Huang
- Institute of Clinical Pharmacology, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
| | - Yan Li
- Guangzhou Cord Blood Bank, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Xiaolan Mo
- Department of Pharmacy, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, Guangdong, China
| | - Jiali Li
- Institute of Clinical Pharmacology, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
- Guangdong Provincial Key Laboratory of New Drug Design and Evaluation, Sun Yat-Sen University School of Pharmaceutical Sciences, Guangzhou, Guangdong, China
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Liu Y, Yuan HL, Duan XL, Xu JL, Qu JH, Chen G, Shi J, Han CX, Ding LL, Jiang M. [Clinical research of HLA-haploidentical peripheral hematopoietic stem cell transplantation following reduced intensity conditioning regimen with hematological malignancy patients over 50 years old]. ZHONGHUA XUE YE XUE ZA ZHI = ZHONGHUA XUEYEXUE ZAZHI 2019; 40:667-672. [PMID: 31495134 PMCID: PMC7342871 DOI: 10.3760/cma.j.issn.0253-2727.2019.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
目的 分析减低剂量预处理单倍型外周血造血干细胞移植(RIC-haplo-PBSCT)治疗50岁以上恶性血液肿瘤患者的疗效。 方法 18例50岁以上恶性血液肿瘤患者纳入研究,男8例,女10例,中位年龄52(50~66)岁;急性髓系白血病(AML)8例,慢性髓性白血病(CML)2例,骨髓增生异常综合征(MDS)5例,急性淋巴细胞白血病(ALL)2例,急性NK细胞白血病(ANKL)1例;采用FAB+ATG(氟达拉滨+阿糖胞苷+白消安+兔抗人胸腺细胞免疫球蛋白)减低剂量预处理方案,输注供者高剂量非去T细胞外周血造血干细胞(PBSC),应用强化移植物抗宿主病(GVHD)预防方案及感染防控措施。 结果 16例患者在移植后15 d获得完全供者嵌合,其中1例在移植后1个月发生移植排斥,其余2例在移植后15 d为混合嵌合并于移植后1个月发生移植排斥。急性GVHD发生率为61.1%(95%CI 49.6%~72.6%),Ⅱ~Ⅳ度急性GVHD发生率为35.4%(95%CI 21.1%~49.7%),Ⅲ/Ⅳ度急性GVHD发生率为13.8%(95%CI 4.7%~22.9%)。2年慢性GVHD累积发生率为38.2%(95%CI 25.5%~50.9%),未发生广泛型慢性GVHD。中位随访14.5(3~44)个月,2年总生存率、无病生存率分别为72.6%(95%CI 60.1%~85.1%)、63.7%(95%CI 49.2%~78.2%),2年累积复发率为31.2%(95%CI 16.5%~45.9%),2年非复发死亡率为12.5%(95%CI 4.2%~20.8%)。 结论 RIC-haplo-PBSCT治疗50岁以上恶性血液肿瘤患者可获得较好的疗效。
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Affiliation(s)
- Y Liu
- Hematologic Disease Center, First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, China; Xinjiang Uygur Autonomous Region Research Institute of Hematology, Urumqi 830061, China
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Yang X, Yang S, Sun A, Qiu H, Tang X, Han Y, Wu D. Impact of cyclosporine-A concentration in T-cell replete haploidentical allogeneic stem cell transplantation. Clin Transplant 2018; 32:e13220. [PMID: 29493007 DOI: 10.1111/ctr.13220] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/01/2018] [Indexed: 01/22/2023]
Abstract
This paper aims to study whether cyclosporine-A (CSA) levels have an impact on the clinical outcome of patients with T-cell replete haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT). We analyzed 140 consecutive patients who had been given T-cell replete haploidentical allo-HSCT in our institute to assess the effect of CSA concentration in the early stages of allo-HSCT on clinical outcomes, such as hematopoietic recovery, acute graft vs host disease (aGVHD), infection, disease-free survival (DFS), and overall survival (OS). The median concentrations of CSA in the blood in the 1st, 2nd, 3rd, and 4th week after allo-HSCT were 218, 235, 263, and 270 ng/mL, respectively. Additionally, 46%, 40%, 27%, and 18% of the patients had CSA blood levels below 200 ng/mL during those weeks. In total, 39 patients developed aGVHD (grade II-IV), for a cumulative incidence of 27.8%, at a median of 32 days. Patients having a low CSA concentration (below 200 ng/mL) in the 3rd week had a higher cumulative incidence of grade II-IV aGVHD (P = .02). In addition, multivariate logistic regression analysis showed that low CSA concentration (below 200 ng/mL) in the 3rd week was an independent risk factor of grade II-IV aGVHD (P = .02; odds ratio = 2.66; 95% CI, 1.15-6.17). However, CSA levels during the first 4 weeks did not have a significant impact on the patients' hematopoietic recovery, infection, DFS, and OS. Our data indicated that adequate management of CSA levels during the peri-engraftment period might improve clinical outcomes for those with T-cell replete haploidentical allo-HSCT.
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Affiliation(s)
- Xiaofei Yang
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Shuo Yang
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Aining Sun
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Huiying Qiu
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Xiaowen Tang
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Yue Han
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
| | - Depei Wu
- Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, China.,Institute of Blood and Marrow Transplantation, Suzhou, China.,Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China
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5
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Murata M. Prophylactic and therapeutic treatment of graft-versus-host disease in Japan. Int J Hematol 2015; 101:467-86. [DOI: 10.1007/s12185-015-1784-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 03/17/2015] [Indexed: 11/29/2022]
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6
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Nygaard M, Hovgaard D, Schjødt IM, Andersen NS, Vindeløv L, Sengeløv H. Oral cyclosporine A treatment is feasible after myeloablative conditioning in allogeneic hematopoietic stem cell transplantation. J Clin Pharm Ther 2015; 40:358-61. [PMID: 25829023 DOI: 10.1111/jcpt.12266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 03/02/2015] [Indexed: 11/27/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE The target level and route of administration of cyclosporine A (CsA) differ between transplantation centres. It is unclear whether oral CsA is sufficient to maintain target level of CsA. CASE SUMMARY We retrospectively analysed data from 48 adult patients, who underwent myeloablative hematopoietic stem cell transplantation. Twenty-one patients (44%) tolerated CsA orally throughout the transplantation period without increased incidence of acute graft versus host disease(aGVHD). Low concentration of CsA in week 2 was associated with increased incidence of aGVHD. WHAT IS NEW AND CONCLUSION Oral administration of CsA is safe, less time-consuming and economically advantageous. Close monitoring of CsA concentration is important.
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Affiliation(s)
- M Nygaard
- Hematological department, National University Hospital Rigshospitalet, Copenhagen, Denmark
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Risk Factors, Pattern and Clinical Outcome of Acute Graft Versus Host Disease in Acute Leukemia Patients Undergoing Allogeneic Stem Cell Transplant. Indian J Hematol Blood Transfus 2015; 31:404-12. [PMID: 26306063 DOI: 10.1007/s12288-014-0499-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/30/2014] [Indexed: 10/24/2022] Open
Abstract
We sought to determine risk factors, pattern and outcome of acute graft versus host disease (aGVHD) in seventy-seven acute leukemia patients who underwent allogeneic stem cell transplant at our centre from January 2008 to March 2013. GVHD prophylaxis with cyclosporine-methotrexate or cyclosporine-mycophenolate mofetil was used. Patients were divided in 2 groups, grade II-IV aGVHD (group A) and grade 0-I aGVHD (group B). Incidence of any grade and grade II-IV aGVHD was 44 and 18 %, respectively. The most common site of aGVHD was gastro-intestinal tract (65 %) followed by skin (35 %). Higher total nucleated cell (TNC) dose infused was associated with increased incidence of grade II-IV aGVHD. Incidence of relapse and incidence of slippage of chimerism was 21 and 36 % in group A while 37 and 27 % in group B respectively. Transplant related mortality (TRM) was 21 % in group A and 13 % in group B. Probability of OS and RFS at 4 years was 63 and 34 % in group A compared with 40 and 38 % in group B, respectively. We conclude that higher TNC dose infused is a risk factor for grade II-IV aGVHD with gut being the commonest site. Grade II-IV aGVHD did not have a significant impact on incidence of relapse, TRM and OS.
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Impact of cyclosporine levels on the development of acute graft versus host disease after reduced intensity conditioning allogeneic stem cell transplantation. Mediators Inflamm 2014; 2014:620682. [PMID: 24623962 PMCID: PMC3929065 DOI: 10.1155/2014/620682] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2013] [Accepted: 12/22/2013] [Indexed: 01/03/2023] Open
Abstract
We analyze the impact of cyclosporine (CsA) levels in the development of acute graft-versus-host disease (aGVHD) after reduced intensity conditioning allogeneic hematopoietic transplantation (allo-RIC). We retrospectively evaluated 156 consecutive patients who underwent HLA-identical sibling allo-RIC at our institution. CsA median blood levels in the 1st, 2nd, 3rd and 4th weeks after allo-RIC were 134 (range: 10–444), 219 (54–656), 253 (53–910) and 224 (30–699) ng/mL; 60%, 16%, 11% and 17% of the patients had median CsA blood levels below 150 ng/mL during these weeks. 53 patients developed grade 2–4 aGVHD for a cumulative incidence of 45% (95% CI 34–50%) at a median of 42 days. Low CsA levels on the 3rd week and sex-mismatch were associated with the development of GVHD. Risk factors for 1-year NRM and OS were advanced disease status (HR: 2.2, P = 0.02) and development of grade 2–4 aGVHD (HR: 2.5, P < 0.01), while there was a trend for higher NRM in patients with a low median CsA concentration on the 3rd week (P = 0.06). These results emphasize the relevance of sustaining adequate levels of blood CsA by close monitoring and dose adjustments, particularly when engraftment becomes evident. CsA adequate management will impact on long-term outcomes in the allo-RIC setting.
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Kwon DH, Jung S, Lee EJ, Lee JY, Moon S, Lee JW, Chung NG, Cho B, Kim HK. Incidence and risk factors for early-onset hypertension after allogeneic hematopoietic stem cell transplantation in children. Korean Circ J 2013; 43:804-10. [PMID: 24385991 PMCID: PMC3875696 DOI: 10.4070/kcj.2013.43.12.804] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2013] [Revised: 10/21/2013] [Accepted: 10/23/2013] [Indexed: 12/28/2022] Open
Abstract
Background and Objectives Survivors of pediatric hematopoietic stem cell transplantation (HSCT) are at risk for developing hypertension. The objectives of this study are to evaluate the prevalence and risk factors of early onset hypertension during the engraftment period after HSCT. Subjects and Methods This is a retrospective study of 157 consecutive patients (mean age at HSCT: 9.1±5.1 years) who underwent HSCT for acute myeloid leukemia (n=47), acute lymphoblastic leukemia (n=43), severe aplastic anemia (n=41), and other reasons (n=26). Blood pressure data were collected at five time points: 0, 7, 14, 21, and 28 days after HSCT. Hypertension was defined as having systolic and/or diastolic blood pressure ≥95th percentile according to age, gender, and height. To analyze the risk factors related to hypertension, data, including patients' demographic and transplant characteristics, were reviewed. Results Hypertension developed in 59 patients (38%), among whom 12 (7.6%) required long term therapy. Thirty-two (54%) patients had systolic and diastolic, 8 (14%) had only systolic, and 19 (32%) had only diastolic hypertension. Younger age, acute graft-versus-host disease, sinusoidal obstruction syndrome, treatment with antifungal agent, and greater increase in serum creatinine (Cr) levels were associated with hypertension. Multivariate analysis showed that younger age at HSCT and greater increase in serum Cr level were independent risk factors for hypertension. Conclusion Prevalence of hypertension during immediate post-HSCT period is high, especially in younger children. A greater increase in Cr after HSCT was significantly associated with hypertension. Further study is needed to elucidate long-term cardiovascular complications in pediatric HSCT survivors.
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Affiliation(s)
- Dae Hyun Kwon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seungwon Jung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun-Jung Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Young Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Sena Moon
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Jae Wook Lee
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Nack Gyun Chung
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Bin Cho
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hack Ki Kim
- Department of Pediatrics, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Graft-versus-host disease after intestinal and multivisceral transplantation. Transplantation 2011; 91:219-24. [PMID: 21076376 DOI: 10.1097/tp.0b013e3181ff86ec] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Graft-versus-host-disease (GVHD) is a rare complication but carries a high mortality after transplantation. We retrospectively evaluated the incidence, risk factors and impact of this complication on the survival outcome of intestinal transplantation at a single center. METHODS 241 patients who underwent intestinal transplantation between March 1994 and July 2007 were analyzed for evidence of GVHD. A diagnosis of GVHD was based on clinical presentations and confirmed by histological findings. RESULTS Of the 241 patients, 22 (9.1%) were diagnosed as GVHD. The median time of GVHD onset was 75 days (range, 14-1,408). The incidence of GVHD was significantly higher in young children than in adults (13.2 versus 4.4%, P = 0.05). The multivisceral graft recipients were more likely to develop GVHD compared with those of isolated small bowel (12.4% versus 4.6%, P = 0.05). The presence of recipient splenectomy was significantly associated with the incidence of GVHD (P = 0.03). The inclusion of the spleen in the multivisceral grafts tended to be at an increased risk of GVHD compared with the group without the spleen transplant (12.3% versus 7.9%, P = 0.43). A total of 16 patients with GVHD died during the entire follow-up. Infection was the leading cause of death in 55% patients. CONCLUSIONS GVHD is a fatal and progressive complication of small bowel transplantation. Younger children, multivisceral graft recipients, and particularly those with splenectomy are at high risk of developing GVHD after transplantation.
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11
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Furukawa T, Kurasaki-Ida T, Masuko M, Tsukada N, Okazuka K, Sato N, Yano T, Abe T, Momoi A, Shibasaki Y, Higashimura M, Karimata K, Moriyama M, Kuroha T, Takizawa J, Toba K, Narita M, Fuse I, Takahashi M, Aizawa Y. Pharmacokinetic and pharmacodynamic analysis of cyclosporine A (CsA) to find the best single time point for the monitoring and adjusting of CsA dose using twice-daily 3-h intravenous infusions in allogeneic hematopoietic stem cell transplantation. Int J Hematol 2010; 92:144-51. [DOI: 10.1007/s12185-010-0610-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2009] [Revised: 05/17/2010] [Accepted: 05/21/2010] [Indexed: 11/25/2022]
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12
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Malard F, Szydlo RM, Brissot E, Chevallier P, Guillaume T, Delaunay J, Ayari S, Dubruille V, Le Gouill S, Mahe B, Gastinne T, Blin N, Saulquin B, Harousseau JL, Moreau P, Mohty M. Impact of cyclosporine-A concentration on the incidence of severe acute graft-versus-host disease after allogeneic stem cell transplantation. Biol Blood Marrow Transplant 2009; 16:28-34. [PMID: 20053329 DOI: 10.1016/j.bbmt.2009.08.010] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2009] [Accepted: 08/20/2009] [Indexed: 12/30/2022]
Abstract
This single-center retrospective study analyzed 85 consecutive patients who underwent allogeneic stem cell transplantation (allo-SCT) with the aim to assess whether there is a correlation between exposure to cyclosporine-A (CsA; as measured by CsA concentrations during the first month after allo-SCT) and the risk for developing severe grade III-IV acute graft-versus-host disease (aGVHD). The median concentrations of CsA in the blood at 1, 2, 3, and 4 weeks after allo-SCT were 348 (range: 172-733), 284 (range: 137-535), 274 (range: 107-649), and 247 (range: 37-695) ng/mL, respectively. Overall, grade II-IV aGVHD occurred in 36 patients (42%) at a median of 29 (range: 6-100) days after allo-SCT. The incidence of grade III-IV aGVHD (n = 20) was 23% (95% confidence interval [CI], 14%-32%). In univariate analysis, patients receiving allo-SCT from an HLA-matched unrelated donor had a higher risk of grade III-IV aGVHD, and patients having the lowest CsA concentration in the first and second weeks after allo-SCT had a significantly higher risk of grade III-IV aGVHD. In a multivariate logistic regression analysis, a higher CsA concentration measured during the first week following graft infusion was the strongest parameter significantly associated with a reduced risk of severe grade II-IV aGVHD (P = .012; relative risk [RR] = 0.24; 95% CI, 0.08-0.73). Of note, when adjusted by donor type, CsA concentration in week 1 remained significantly associated with risk of severe grade II-IV aGVHD (P = .014). We conclude that precise monitoring of CsA concentrations and adjustment of CsA dose early after allo-SCT may be effective to prevent onset of severe aGVHD.
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Affiliation(s)
- Florent Malard
- Centre Hospitalier et Universitaire (CHU) de Nantes, Service d'Hématologie Clinique, Nantes, France
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13
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Barkholt L. Importance of CsA drug monitoring in SCT recipients to minimize GVHD and maximize graft vs. leukemia. Pediatr Transplant 2009; 13:400-3. [PMID: 18992059 DOI: 10.1111/j.1399-3046.2008.01057.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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14
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Determination of initial i.v. CYA dosage to achieve target AUC values in pediatric hematopoietic stem cell transplant patients. Bone Marrow Transplant 2008; 42:455-9. [DOI: 10.1038/bmt.2008.189] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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15
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Xu CF, Zhu LX, Xu XM, Chen WC, Wu DP. Endoscopic diagnosis of gastrointestinal graft-versus-host disease. World J Gastroenterol 2008; 14:2262-7. [PMID: 18407606 PMCID: PMC2703857 DOI: 10.3748/wjg.14.2262] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate the diagnostic value of endoscopy in patients with gastrointestinal graft-versus-host disease (GI GVHD).
METHODS: We identified 8 patients with GI GVHD following allogeneic hematopoietic stem cell trans-plantation (HSCT). GVHD was defined histologically as the presence of gland apoptosis, not explained by other inflammatory or infectious etiologies.
RESULTS: The symptoms of GI GVHD included anorexia, nausea, vomiting, watery diarrhea, abdominal pain, GI bleeding, etc. Upper endoscopic appearance varied from subtle mucosal edema, hyperemia, erythema to obvious erosion. Colonoscopic examination showed diffuse edema, hyperemia, patchy erosion, scattered ulcer, sloughing and active bleeding. Histological changes in GI GVHD included apoptosis of crypt epithelial cells, dropout of crypts, and lymphocytic infiltration in epithelium and lamina propria. The involvement of stomach and rectocolon varied from diffuse to focal.
CONCLUSION: Endoscopy may play a significant role in early diagnosis of GI GVHD patients following allogeneic HSCT, and histologic examination of gastrointestinal biopsies is needed to confirm the final diagnosis.
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