Original articleAlimentary tractAssociation Between Low Plasma Level of Citrulline Before Allogeneic Hematopoietic Cell Transplantation and Severe Gastrointestinal Graft vs Host Disease
Section snippets
Patients and Methods
The study was performed according to institutional guidelines and in accordance with the Declaration of Helsinki. The analyses in the present study were performed on data entered into a prospective database of patients undergoing allo-HCT between 2013 and 2015 at the Lille University Hospital. All enrolled patients provided their written and informed consent before undergoing allo-HCT. All data were anonymized for use for research purposes.
Patient Outcome
Ninety-six patients (50%) developed aGvHD: 36 (19%) grade I GvHD, 25 (13%) grade II GvHD, and 35 (18%) grade III-IV GvHD. Ninety-five patients (50%) did not develop GvHD (grade 0 GvHD). Among patients who developed aGvHD, 78 (81%) had skin involvement, 11 (11%) had liver, and 37 (39%) had GI involvement. Among patients with GI involvement, 33 (89%) had stage 2–4 GI-GvHD. The median follow-up was 944 days (range, 891–997) and the OS estimated for the whole cohort was 57% at 2 years. The OS at 2
Discussion
The benefits of allo-HCT remain hampered by severe aGvHD and particularly GI-GvHD. The aim of this study was to assess plasma citrulline level before conditioning treatment as a predictive factor of GI-GvHD in a large cohort of patients undergoing allo-HCT. We observed that low plasma citrulline level (≤26 μmol/L) before conditioning was strongly associated with higher cumulative incidence of stage 2–4 GI-GvHD, grade III-IV GvHD, resulting in significant higher NRM. Pretransplant low citrulline
Acknowledgments
The authors thank the staff of the hematology department of the University Hospital of Lille, France, for patients’ recruitment and blood sample collection. The authors acknowledge Marie-Adelaide Bout and the laboratory of metabolism of the University Hospital of Lille, France, for the amino acid analyses for material support. The authors thank the Lille Inflammation Research International Center of UMR 995 Inserm and the DigestScience foundation for its support.
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Conflicts of interest The authors disclose no conflicts.
Funding This study was supported by a grant from Nutricia Nutrition Clinique on behalf of the Société Francophone Nutrition Clinique et Métabolique awarded to Thomas Hueso.