Features of gastrointestinal acute graft-versus-host disease in children undergoing hematopoietic stem cell transplantation

Abstract

Objectives: Graft-versus-host disease (GVHD) commonly affects the gastrointestinal (GI) tract among children who undergo hematopoietic stem cell transplantation (HSCT). Studies concerning GI-acute GVHD (aGVHD) in developing countries are limited. Therefore, our aims were (1) to demonstrate clinical characteristics, endoscopic and histopathological findings in children with GI-aGVHD post-HSCT and (2) to compare features, risk factors, and clinical outcomes of children with GI-aGVHD versus non GI-aGVHD. Methods: A retrospective single-center study was conducted on patients receiving the first successful HSCT aged <20 years old between January 2011 and December 2020. The patients were divided into groups with GI-aGVHD (clinically or endoscopy-histopathologically diagnosed) and without GI-aGVHD. Various aforementioned data were recorded to compare the risk factors and clinical outcomes of children with and without GI-aGVHD. Results: Among 246 children post-HSCT, we identified 42 cases (17%) with GI-aGVHD (32 cases with the clinical diagnosis and 10 cases with endoscopy-histopathology confirmed diagnosis) and 204 patients without GI-aGVHD. When compared with children without GI-aGVHD, the GI-aGVHD group had higher rates of hypovolemic shock, renal failure, more extended hospital stays, and deaths (all p < 0.05). The GI-aGVHD group also had a higher proportion of cases with nonhematologic malignancy (odds ratio [OR] = 2.34, 95% confidence interval [CI] = 1.01–5.41, p = 0.047) and cytomegalovirus (CMV) reactivation before the GI-aGVHD episode (OR = 2.22, 95% CI = 1.09–4.51, p = 0.027). Conclusions: GI-aGVHD after HSCT leads to increased morbidity and death. Underlying nonhematologic malignancy and history of CMV reactivation are associated with GI-aGVHD. Direct links between the aforementioned factors and the development of GI-aGVHD merit future studies.