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Early clinical, histological, and immunohistochemical findings in suspected acute graft‐versus‐host disease and their association with patient outcomes
Author(s) -
GarcíaRomero Maria Teresa,
SáezdeOcariz Marimar,
HernándezZepeda Carolina,
Reyes Montserrat,
García de la Puente Silvestre,
RidauraSanz Cecilia,
LópezHernández Gerardo,
OlayaVargas Alberto
Publication year - 2020
Publication title -
pediatric dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.542
H-Index - 73
eISSN - 1525-1470
pISSN - 0736-8046
DOI - 10.1111/pde.14152
Subject(s) - medicine , odds ratio , gastroenterology , hematopoietic stem cell transplantation , biopsy , graft versus host disease , retrospective cohort study , multivariate analysis , disease , stage (stratigraphy) , skin biopsy , pathology , paleontology , biology
Abstract Background/Objectives Acute graft‐versus‐host disease (aGVHD) is a serious condition after allogeneic hematopoietic stem cell transplantation (HSCT), frequently involving skin, gut, and liver. It can be difficult to diagnose early, yet this is vital for adequate management. We sought to identify initial clinical and histopathological features in children with suspected GVHD and the association with clinical course and outcomes. Methods Retrospective study of patients with skin biopsies for suspected aGVHD from 2006 to 2016. We collected demographic and clinical information, histologic, and immunohistochemical (IHC) findings, and outcomes during follow‐up. Bivariate and multivariate analyses were done to identify risk factors associated with remission, development of severe/life‐threatening aGVHD, and mortality. Results We included 42 patients, 15 females. Skin manifestations occurred 51 days (median) after HSCT. On biopsy, 76.2% had mild (stage 1‐2) skin aGVHD; during the course of the disease, severity and systemic involvement increased to global grade III/IV in 66.6%. All patients received treatment; 15 are in remission from aGVHD and 23 have died. Histologic features were diagnostic in 83.3%. On bivariate and multivariate analysis, we identified initial clinical and histologic findings that were associated with the measured outcomes: odds of remission from aGVHD were increased when focal vacuolar changes were found on skin biopsy (OR 6.028; 95%CI:1.253‐28.992) but decreased by initial hepatic aGVHD (OR 0.112; 95%CI: 0.017‐0.748); severe/life‐threatening aGVHD was associated with initial gastrointestinal aGVHD (OR 6.054; 95%CI:1.257‐29.159); and odds of mortality were decreased with male donor (OR 0.056; 95%CI:0.004‐0.804), nulliparous female donor (OR 0.076; 95%CI:0.009‐0.669), and focal vacuolar changes on skin biopsy (OR 0.113; 95%CI:0.017‐0.770). Conclusions We found novel indicators predictive of remission, severity, and mortality in children with aGVHD. Further studies of this condition in children are needed.