Acute bleeding after allogeneic bone marrow transplantation: Association with graft versus host disease and effect on survival

Shoshan Nevo, Cheryl Enger, Valerie Swan, Kirk J. Wojno, Alice K. Fuller, Viki Altomonte, Hayden G. Braine, Stephen J. Noga, Georgia Boyce Vogelsang

Research output: Contribution to journalArticle

Abstract

Background. Hemorrhagic complications are frequently implicated clinically for the high morbidity and mortality of acute graft versus host disease (GVHD), however, only few reports characterize the incidence and timing of bleeding in relation to GVHD, and essentially no study has quantified the effect of bleeding on survival of allogeneic patients with GVHD. This study examines the association of bleeding with acute GVHD and the effect of both complications on survival. Methods. A total of 463 allogeneic patients transplanted at the Johns Hopkins Hospital, were included in the study. Bleeding evaluation was based on daily scores of intensity and blood transfusions. All bleeding sites were recorded. GVHD staging was defined by the extent of rash, serum bilirubin, diarrhea, and confirmatory histology. Results. The incidence of GVHD was 27.4%, bleeding occurred in 40.2%. The incidence of bleeding was higher in patients with GVHD as compared with non- GVHD, and correlated with GVHD severity. The higher bleeding incidence in GVHD was due to gastrointestinal hemorrhage, hemorrhagic cystitis, and pulmonary hemorrhage. While the majority of bleeding (51/75) in non-GVHD patients initiated within 30 days after bone marrow transplantation (BMT), only 32.3% (21/65) of the bleeding in the GVHD group initiated within 30 days, and the risk for bleeding continued until day 100. Bleeding was a late event compared to GHD, however, most bleeding episodes were associated with active GVHD. Both GVHD and bleeding were individually associated with reduced survival, with profound additive adverse effect: median survival in 221 nonbleeding non-GVHD was >83.2 months, GVHD nonbleeding (39 patients) had median of 10.6 months, bleeding non-GVHD (99 patients) had median of 4.3 months, and median survival of the GVHD bleeding group (85 patients) was 3.2 months. Conclusions. Our results support an association of bleeding with acute GVHD, suggesting that GVHD is a risk factor for bleeding after BMT. The occurrence of bleeding clearly identified poor outcome subgroup within GVHD, suggesting further evaluation for clinical application of bleeding in the assessment of GVHD severity.

Original languageEnglish (US)
Pages (from-to)681-689
Number of pages9
JournalTransplantation
Volume67
Issue number5
StatePublished - Mar 15 1999

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Homologous Transplantation
Graft vs Host Disease
Bone Marrow Transplantation
Hemorrhage
Survival
Incidence
Cystitis
Gastrointestinal Hemorrhage

ASJC Scopus subject areas

  • Transplantation
  • Immunology

Cite this

Acute bleeding after allogeneic bone marrow transplantation : Association with graft versus host disease and effect on survival. / Nevo, Shoshan; Enger, Cheryl; Swan, Valerie; Wojno, Kirk J.; Fuller, Alice K.; Altomonte, Viki; Braine, Hayden G.; Noga, Stephen J.; Vogelsang, Georgia Boyce.

In: Transplantation, Vol. 67, No. 5, 15.03.1999, p. 681-689.

Research output: Contribution to journalArticle

Nevo, S, Enger, C, Swan, V, Wojno, KJ, Fuller, AK, Altomonte, V, Braine, HG, Noga, SJ & Vogelsang, GB 1999, 'Acute bleeding after allogeneic bone marrow transplantation: Association with graft versus host disease and effect on survival', Transplantation, vol. 67, no. 5, pp. 681-689.
Nevo S, Enger C, Swan V, Wojno KJ, Fuller AK, Altomonte V et al. Acute bleeding after allogeneic bone marrow transplantation: Association with graft versus host disease and effect on survival. Transplantation. 1999 Mar 15;67(5):681-689.
Nevo, Shoshan ; Enger, Cheryl ; Swan, Valerie ; Wojno, Kirk J. ; Fuller, Alice K. ; Altomonte, Viki ; Braine, Hayden G. ; Noga, Stephen J. ; Vogelsang, Georgia Boyce. / Acute bleeding after allogeneic bone marrow transplantation : Association with graft versus host disease and effect on survival. In: Transplantation. 1999 ; Vol. 67, No. 5. pp. 681-689.
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abstract = "Background. Hemorrhagic complications are frequently implicated clinically for the high morbidity and mortality of acute graft versus host disease (GVHD), however, only few reports characterize the incidence and timing of bleeding in relation to GVHD, and essentially no study has quantified the effect of bleeding on survival of allogeneic patients with GVHD. This study examines the association of bleeding with acute GVHD and the effect of both complications on survival. Methods. A total of 463 allogeneic patients transplanted at the Johns Hopkins Hospital, were included in the study. Bleeding evaluation was based on daily scores of intensity and blood transfusions. All bleeding sites were recorded. GVHD staging was defined by the extent of rash, serum bilirubin, diarrhea, and confirmatory histology. Results. The incidence of GVHD was 27.4{\%}, bleeding occurred in 40.2{\%}. The incidence of bleeding was higher in patients with GVHD as compared with non- GVHD, and correlated with GVHD severity. The higher bleeding incidence in GVHD was due to gastrointestinal hemorrhage, hemorrhagic cystitis, and pulmonary hemorrhage. While the majority of bleeding (51/75) in non-GVHD patients initiated within 30 days after bone marrow transplantation (BMT), only 32.3{\%} (21/65) of the bleeding in the GVHD group initiated within 30 days, and the risk for bleeding continued until day 100. Bleeding was a late event compared to GHD, however, most bleeding episodes were associated with active GVHD. Both GVHD and bleeding were individually associated with reduced survival, with profound additive adverse effect: median survival in 221 nonbleeding non-GVHD was >83.2 months, GVHD nonbleeding (39 patients) had median of 10.6 months, bleeding non-GVHD (99 patients) had median of 4.3 months, and median survival of the GVHD bleeding group (85 patients) was 3.2 months. Conclusions. Our results support an association of bleeding with acute GVHD, suggesting that GVHD is a risk factor for bleeding after BMT. The occurrence of bleeding clearly identified poor outcome subgroup within GVHD, suggesting further evaluation for clinical application of bleeding in the assessment of GVHD severity.",
author = "Shoshan Nevo and Cheryl Enger and Valerie Swan and Wojno, {Kirk J.} and Fuller, {Alice K.} and Viki Altomonte and Braine, {Hayden G.} and Noga, {Stephen J.} and Vogelsang, {Georgia Boyce}",
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T1 - Acute bleeding after allogeneic bone marrow transplantation

T2 - Association with graft versus host disease and effect on survival

AU - Nevo, Shoshan

AU - Enger, Cheryl

AU - Swan, Valerie

AU - Wojno, Kirk J.

AU - Fuller, Alice K.

AU - Altomonte, Viki

AU - Braine, Hayden G.

AU - Noga, Stephen J.

AU - Vogelsang, Georgia Boyce

PY - 1999/3/15

Y1 - 1999/3/15

N2 - Background. Hemorrhagic complications are frequently implicated clinically for the high morbidity and mortality of acute graft versus host disease (GVHD), however, only few reports characterize the incidence and timing of bleeding in relation to GVHD, and essentially no study has quantified the effect of bleeding on survival of allogeneic patients with GVHD. This study examines the association of bleeding with acute GVHD and the effect of both complications on survival. Methods. A total of 463 allogeneic patients transplanted at the Johns Hopkins Hospital, were included in the study. Bleeding evaluation was based on daily scores of intensity and blood transfusions. All bleeding sites were recorded. GVHD staging was defined by the extent of rash, serum bilirubin, diarrhea, and confirmatory histology. Results. The incidence of GVHD was 27.4%, bleeding occurred in 40.2%. The incidence of bleeding was higher in patients with GVHD as compared with non- GVHD, and correlated with GVHD severity. The higher bleeding incidence in GVHD was due to gastrointestinal hemorrhage, hemorrhagic cystitis, and pulmonary hemorrhage. While the majority of bleeding (51/75) in non-GVHD patients initiated within 30 days after bone marrow transplantation (BMT), only 32.3% (21/65) of the bleeding in the GVHD group initiated within 30 days, and the risk for bleeding continued until day 100. Bleeding was a late event compared to GHD, however, most bleeding episodes were associated with active GVHD. Both GVHD and bleeding were individually associated with reduced survival, with profound additive adverse effect: median survival in 221 nonbleeding non-GVHD was >83.2 months, GVHD nonbleeding (39 patients) had median of 10.6 months, bleeding non-GVHD (99 patients) had median of 4.3 months, and median survival of the GVHD bleeding group (85 patients) was 3.2 months. Conclusions. Our results support an association of bleeding with acute GVHD, suggesting that GVHD is a risk factor for bleeding after BMT. The occurrence of bleeding clearly identified poor outcome subgroup within GVHD, suggesting further evaluation for clinical application of bleeding in the assessment of GVHD severity.

AB - Background. Hemorrhagic complications are frequently implicated clinically for the high morbidity and mortality of acute graft versus host disease (GVHD), however, only few reports characterize the incidence and timing of bleeding in relation to GVHD, and essentially no study has quantified the effect of bleeding on survival of allogeneic patients with GVHD. This study examines the association of bleeding with acute GVHD and the effect of both complications on survival. Methods. A total of 463 allogeneic patients transplanted at the Johns Hopkins Hospital, were included in the study. Bleeding evaluation was based on daily scores of intensity and blood transfusions. All bleeding sites were recorded. GVHD staging was defined by the extent of rash, serum bilirubin, diarrhea, and confirmatory histology. Results. The incidence of GVHD was 27.4%, bleeding occurred in 40.2%. The incidence of bleeding was higher in patients with GVHD as compared with non- GVHD, and correlated with GVHD severity. The higher bleeding incidence in GVHD was due to gastrointestinal hemorrhage, hemorrhagic cystitis, and pulmonary hemorrhage. While the majority of bleeding (51/75) in non-GVHD patients initiated within 30 days after bone marrow transplantation (BMT), only 32.3% (21/65) of the bleeding in the GVHD group initiated within 30 days, and the risk for bleeding continued until day 100. Bleeding was a late event compared to GHD, however, most bleeding episodes were associated with active GVHD. Both GVHD and bleeding were individually associated with reduced survival, with profound additive adverse effect: median survival in 221 nonbleeding non-GVHD was >83.2 months, GVHD nonbleeding (39 patients) had median of 10.6 months, bleeding non-GVHD (99 patients) had median of 4.3 months, and median survival of the GVHD bleeding group (85 patients) was 3.2 months. Conclusions. Our results support an association of bleeding with acute GVHD, suggesting that GVHD is a risk factor for bleeding after BMT. The occurrence of bleeding clearly identified poor outcome subgroup within GVHD, suggesting further evaluation for clinical application of bleeding in the assessment of GVHD severity.

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