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Trajectories of acute graft-versus-host disease and mortality in critically ill allogeneic-hematopoietic stem cell recipients: the Allo-GRRR-OH score

Bone Marrow Transplantation volume 55, pages 1966–1974 (2020)Cite this article

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Abstract

Acute graft-versus-host disease (aGVHD) is a major cause of morbidity mortality in critically ill hematopoietic stem cell transplantation recipients. We assessed aGVHD trajectories in 191 allogeneic-HSCT recipients (age 42 (27–46)) admitted to our ICU between 2005 and 2015. aGVHD affected 130 (68%) patients (including 90% who underwent steroid therapy at a dose of 2 (2–2) mg/kg) and was graded 3 or 4 in 31% of the patients. Trajectories of aGVHD were clustered in four groups: (1) no aGVHD, (2) controlled aGVHD, (3) uncontrolled aGVHD (active, stable, or worsening), and (4) newly diagnosed and untreated aGVHD. Patients with controlled aGVHD and those admitted at the onset of aGVHD had similar survival than patients who never experienced aGVHD. By multivariable analysis, the dynamic assessment of aGVHD was independently associated with 90-day mortality, in addition to the admission to the ICU for acute respiratory failure, acute kidney injury or acute liver failure, and sepsis-related organ failure assessment score at admission. In conclusion, these findings suggest that GVHD cannot be assessed as a binary variable and at a single time point. Patients in whom GVHD is not uncontrolled with corticosteroids should have the same goals of ICU care than patients without GVHD.

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Fig. 1: Patient’s flow diagram.
Fig. 2: Survival as a function of aGVHD trajectories.
Fig. 3: Survival as a function of the allo-GRRR-OH score.

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Acknowledgements

This work was supported by the Groupe de Recherche en Réanimation Oncohématologique (Grrr-OH).

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Author notes

  1. These authors contributed equally: Claire Pichereau, Etienne Lengliné

Authors and Affiliations

  1. Medical Intensive Care Unit, Hôpital Saint-Louis, AP-HP, Université Paris Diderot, Paris, France

    Claire Pichereau, Etienne Lengliné, Sandrine Valade, Etienne Ghrenassia, Virginie Lemiale & Elie Azoulay

  2. Hematology Transplantation, Hôpital Saint Louis, AP-HP, Paris, France

    Etienne Lengliné, David Michonneau & Gérard Socié

  3. Université de Paris, INSERM U976, F-75010, Paris, France

    David Michonneau & Gérard Socié

  4. ECSTRA Team, CRESS (UMR 1153), INSERM, Université Paris Diderot Paris, Paris, France

    Elie Azoulay

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Contributions

EA coordinated the research; CP, EL, VL, SV, EG, GS, and DM collected and assembled the data; EA and EL performed the statistical analysis. CP, EL, GS, and EA wrote the paper. All authors analyzed the data and approved the final manuscript.

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Correspondence to Elie Azoulay.

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Pichereau, C., Lengliné, E., Valade, S. et al. Trajectories of acute graft-versus-host disease and mortality in critically ill allogeneic-hematopoietic stem cell recipients: the Allo-GRRR-OH score. Bone Marrow Transplant 55, 1966–1974 (2020). https://doi.org/10.1038/s41409-020-0857-x

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