Variables at or before the symptomatic onset of gastrointestinal GVHD that are more common in patients whose GVHD will run a more severe course
| Variable . | Comments . |
|---|---|
| Unrelated donor (HLA mismatched > matched) | Less likely to respond to initial therapy than patients with related or cord blood donors12 |
| Diarrheal volume | Greater volume correlates with refractoriness to initial treatment with prednisone.6,12 |
| Total serum bilirubin | Worse outcome with total serum bilirubin increase from 1 to 3 mg/dL or when jaundice is present at GVHD onset12,14-17 |
| Serum albumin change | Abrupt fall of serum albumin ≥0.5 g/dL before onset of symptoms predicts grade 3 to 4 GVHD in patients who received reduced-intensity conditioning.10 |
| Fecal α-1 antitrypsin | Measures a luminal protein that cannot be digested by proteolytic enzymes; reflects gut protein loss8,9 |
| Fecal calprotectin | Calcium-binding protein in neutrophils; reflects neutrophilic mucosal inflammation in inflammatory bowel disease and gut GVHD9 |
| Skin changes | More extensive skin GVHD is a predictor of severity and need for higher doses of prednisone.12,18 |
| Endoscopic findings | Ulceration and sloughing of mucosa6,19 |
| Mucosal histologic findings | Infiltrating neutrophils16 |
| Increased apoptotic cells16 | |
| Increased eosinophils20 | |
| Low Paneth cell numbers21 | |
| Crypt loss22 | |
| Ulceration6 | |
| Pericapillary hemorrhage23 | |
| Serum biomarkers | Increased levels with more severe GVHD: TIM3, sTNFR1, ST2, IL-6, Reg3α24-29 |
| Endothelial markers | Loss of thrombomodulin expression in gut mucosal biopsies30 |
| Increased blood levels of angiopoietin-231 | |
| Changes in circulating angiogenic factors32 |
| Variable . | Comments . |
|---|---|
| Unrelated donor (HLA mismatched > matched) | Less likely to respond to initial therapy than patients with related or cord blood donors12 |
| Diarrheal volume | Greater volume correlates with refractoriness to initial treatment with prednisone.6,12 |
| Total serum bilirubin | Worse outcome with total serum bilirubin increase from 1 to 3 mg/dL or when jaundice is present at GVHD onset12,14-17 |
| Serum albumin change | Abrupt fall of serum albumin ≥0.5 g/dL before onset of symptoms predicts grade 3 to 4 GVHD in patients who received reduced-intensity conditioning.10 |
| Fecal α-1 antitrypsin | Measures a luminal protein that cannot be digested by proteolytic enzymes; reflects gut protein loss8,9 |
| Fecal calprotectin | Calcium-binding protein in neutrophils; reflects neutrophilic mucosal inflammation in inflammatory bowel disease and gut GVHD9 |
| Skin changes | More extensive skin GVHD is a predictor of severity and need for higher doses of prednisone.12,18 |
| Endoscopic findings | Ulceration and sloughing of mucosa6,19 |
| Mucosal histologic findings | Infiltrating neutrophils16 |
| Increased apoptotic cells16 | |
| Increased eosinophils20 | |
| Low Paneth cell numbers21 | |
| Crypt loss22 | |
| Ulceration6 | |
| Pericapillary hemorrhage23 | |
| Serum biomarkers | Increased levels with more severe GVHD: TIM3, sTNFR1, ST2, IL-6, Reg3α24-29 |
| Endothelial markers | Loss of thrombomodulin expression in gut mucosal biopsies30 |
| Increased blood levels of angiopoietin-231 | |
| Changes in circulating angiogenic factors32 |