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.
Analysis of gastrointestinal and hepatic chronic graft-versus-host [corrected] disease manifestations on major outcomes: a chronic graft-versus-host [corrected] disease consortium study.
J. Pidala,X. Chai,B. Kurland,Y. Inamoto,M. Flowers,J. Palmer,N. Khera,M. Jagasia,C. Cutler,M. Arora,G. Vogelsang,Stephanie J. Lee
Published 2013 in Biology of Blood and Marrow Transplantation
ABSTRACT
PUBLICATION RECORD
- Publication year
2013
- Venue
Biology of Blood and Marrow Transplantation
- Publication date
2013-02-06
- Fields of study
Medicine
- Identifiers
- External record
- Source metadata
Semantic Scholar, PubMed
CITATION MAP
EXTRACTION MAP
CLAIMS
CONCEPTS
- alanine aminotransferase
A liver enzyme laboratory measure used to characterize hepatic involvement.
Aliases: ALT
- alkaline phosphatase
A liver-associated enzyme laboratory measure used to characterize hepatic involvement.
Aliases: ALP
- chronic graft-versus-host disease
A chronic post-transplant immune complication affecting multiple organs, which is the disease context for the cohort analyzed here.
Aliases: chronic GVHD, cGVHD
- elevated bilirubin
An increased bilirubin laboratory abnormality used here as one measure of hepatic involvement.
Aliases: bilirubin elevation
- esophageal involvement
Chronic GVHD involvement of the esophagus as a specific gastrointestinal site manifestation.
Aliases: esophagus involvement
- gastrointestinal involvement
Manifestations of chronic GVHD involving the gastrointestinal tract, including site-specific upper, lower, and esophageal involvement.
Aliases: GI involvement
- gi score greater than zero
A gastrointestinal severity indicator indicating that the composite GI score is above zero.
Aliases: GI score > 0
- hepatic involvement
Manifestations of chronic GVHD involving the liver, captured here through laboratory and scoring measures.
Aliases: liver involvement
- lower gi involvement
Chronic GVHD involvement of the lower gastrointestinal tract as a site-specific GI manifestation.
Aliases: lower gastrointestinal involvement
- nih liver score
A National Institutes of Health organ score used to grade liver involvement in chronic GVHD.
Aliases: liver score
- nonrelapse mortality
Death without prior relapse of the underlying malignancy, used as a competing clinical endpoint.
Aliases: NRM
- overall survival
Time from cohort assessment to death from any cause, used as a major survival endpoint.
Aliases: OS
- quality of life
Patient-reported quality-of-life assessment collected at cohort visits.
Aliases: QOL
- symptoms
Patient-reported symptom burden assessed in the chronic GVHD cohort visits.
Aliases: symptom burden
- upper gi involvement
Chronic GVHD involvement of the upper gastrointestinal tract as a site-specific manifestation.
Aliases: upper gastrointestinal involvement
REFERENCES
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