Publication: Chronic graft-versus-host disease in children and adolescents with thalassemia after hematopoietic stem cell transplantation
Issued Date
2021-04-01
Resource Type
ISSN
18653774
09255710
09255710
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2-s2.0-85098480882
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Mahidol University
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SCOPUS
Bibliographic Citation
International Journal of Hematology. Vol.113, No.4 (2021), 556-565
Suggested Citation
Oranooj Lertkovit, Usanarat Anurathapan, Suradej Hongeng, Nintita Sripaiboonkit Thokanit, Samart Pakakasama Chronic graft-versus-host disease in children and adolescents with thalassemia after hematopoietic stem cell transplantation. International Journal of Hematology. Vol.113, No.4 (2021), 556-565. doi:10.1007/s12185-020-03055-w Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/78335
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Title
Chronic graft-versus-host disease in children and adolescents with thalassemia after hematopoietic stem cell transplantation
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Abstract
Data on chronic graft-versus-host disease (cGVHD) in patients with thalassemia after hematopoietic stem cell transplantation (HSCT) have not been specifically explored. The present study aimed to determine the incidence and clinical manifestations of cGVHD in children and adolescents with thalassemia who underwent HSCT and to compare healthcare utilization and medical cost between patients with and without cGVHD. We retrospectively analyzed the presentations, treatments, and outcomes of historical cGVHD (Seattle criteria), post-transplant admissions and direct medical cost for HSCT patients (n = 66). We used the 2014 NIH consensus criteria to reclassify the diagnosis of cGVHD (NIH cGVHD). Among 28 historical cGVHD patients, 13 (46.4%) fulfilled the NIH criteria. Reasons why the NIH criteria were unmet were reclassification as late acute GVHD and presence of distinctive signs without confirmatory tests. At 2 years after HSCT, the cumulative incidence of NIH cGVHD was 21.67% (95% CI, 12.31–32.74%). Lung cGVHD was associated with inferior survival with a hazard ratio of 13.6 (95% CI, 1.42–131.48). Patients with historical cGVHD had significantly increased frequency of inpatient admissions and medical cost. In conclusion, cGVHD was common in children with thalassemia receiving HSCT. Patients with cGVHD required prolonged immunosuppressive treatment and incurred high medical expenses.