Clinical Severity Scores in Gastrointestinal Graft-Versus-Host Disease

Abraham, Julie1; Janin, Anne2,3; Gornet, Jean-Marc4; de Latour, Régis Peffault1; Robin, Marie1; Xhaard, Aliénor1; de Fontebrune, Flore Sicre1; Mary, Jean Yves5; Allez, Matthieu4; Porcher, Raphael5; Socié, Gérard1,6,7

doi: 10.1097/01.TP.0000438209.50089.60
Clinical and Translational Research

Background: The clinical prognosis of gastrointestinal (GI) graft-versus-host disease (GvHD) is based on either a clinical staging system or histological or endoscopic findings. How these different scores correlate with each other and which have the greater impact on transplantation outcomes is, however, not clear.

Methods: Clinical, pathological, and endoscopic findings of the upper GI tract on 201 patients who underwent allogeneic hematopoietic stem cell transplantation were reviewed. The association between clinical, histological, and endoscopy grading was assessed by Kendall correlation coefficient. The agreement between grading systems was evaluated by kappa statistics. Factors associated with survival or steroid resistance were analyzed by proportional hazard models.

Results: At disease onset, no strong association was found between pathological and clinical grade at disease onset (τ=0.034, P=0.6). In contrast, endoscopy score and clinical grades were strongly associated (τ=0.37, P<0.001). The Kappa concordance coefficient (0.20) between histological and endoscopy scores was poor. However, by multivariate analysis all three scores significantly predicted survival rates

Conclusions: Clinical, histological, and endoscopic scores poorly correlated with each other when estimated at the GI-GvHD onset. However, all three severe initial scores independently predict poor outcome. Of interest, clinical and endoscopic scores predict resistance to steroids while pathological does not.

1 AP-HP Hospital Saint Louis, Hematology/Transplantation, Paris, France.

2 AP-HP Hospital Saint Louis, Pathology, Paris, France.

3 Inserm U 728, Paris, France.

4 AP-HP Hospital Saint Louis, Gastroenterology, Paris, France.

5 AP-HP Hospital Saint Louis, DBIM, Paris, France.

6 Inserm U 940, Paris, France.

7 Address correspondence to: Gérard Socie, M.D., Ph.D., Hematology Transplantation, Hospital Saint Louis; 1 avenue Claude Vellefaux; 75475, Paris Cedex 10, France.

The authors declare no funding or conflicts of interest.

E-mail: gerard.socie@sls.aphp.fr

J.A., A.J., and J.-M.G. contributed equally to this work.

R.P. and G.S. should be considered as chairing last authorship.

G.S. participated in designing the study, analyzing the data, and writing the article. J.A. participated in collecting and analyzing the data. A.J. participated in performing all pathological analyses and writing the article. J.-M.G. participated in performing endoscopy and writing the article. R.P.L. participated in writing the article. M.R. participated in writing the article. A.X. participated in writing the article. F.S.F. participated in writing the article. J.Y.M. participated in analyzing the data and writing the article. M.A. participated in performing endoscopy and writing the article. R.P. participated in performing all statistical analyses and writing the article.

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

Received 4 September 2013. Revision requested 18 September 2013.

Accepted 23 October 2013.

© 2014 by Lippincott Williams & Wilkins