Graft-versus-Host Disease of the Gut: A Histologic Activity Grading System and Validation.
Graft-versus-Host Disease of the Gut: A Histologic Activity Grading System and Validation.
复制标题
DOI：
10.1016/j.bbmt.2017.05.017
复制
发表时间：
2017-09
期刊：
影响因子：
--
通讯作者：
Shulman HM
中科院分区：
文献类型：
--
作者：
Myerson D;Steinbach G;Gooley TA;Shulman HM
对造血细胞移植受者进行肠道活检以评估移植物抗疾病（GVHD）的病理解释是公认的，并补充了临床和内镜检查结果。然而，GVHD的组织学活动分级是有争议的，试图预测预后或对治疗的反应基本上是不成功的。移植物抗宿主病在其病程的早期被诊断出来，提高了病理分级系统可以被有益地修改的可能性。我们开发了一种组织学活动分级系统，旨在取代常用的改良Lerner分级系统。我们的系统根据凋亡细胞的平均频率将低水平的Lerner I级分类分为4个活性等级类别。结果表示为顺序类别，GVHD为轻微、轻度、中度、重度组织学活性或重度组织学活性伴破坏（活性等级1-5）。在一项回顾性研究中，研究了87例连续病例的201份胃、十二指肠和结直肠移植后标本（中位数48天，范围18-1479天），这些标本在最初诊断时已进行了活动分级。大多数诊断为GVHD的活检是低度-最小（11%）或轻度（71%）的组织学活动。我们假设，更高的活动等级应该与更多的治疗干预有关。在合并的所有部位标本中，治疗增加的几率随着活动等级的增加而增加[比值比（OR）= 2.9（1.9-4.5），p=<.0001]。因此，我们的分级系统得到了验证。为了研究活动分级是否与先前未划分的Lerner I级类别中的治疗相关，分析仅限于这174份所有部位标本。验证结果相似[OR = 3.1（1.3-7.2），p=.009]。有趣的是，这一结果表明，在Lerner I级分类中隐藏着有用的信息，这些信息可能会指导立即采取行动的治疗决策。该组织学活性分级系统已在我们机构使用超过2年，具有良好的可接受性。
The pathologic interpretation of gut biopsies in hematopoietic cell transplant recipients to assess graft-versus-disease (GVHD) is well accepted and supplements clinical and endoscopic findings. However, the histologic activity grading of GVHD is controversial, with attempts to predict prognosis or response to treatment largely unsuccessful. GVHD is being diagnosed earlier in its course, raising the possibility that the pathologic grading system can be profitably modified. We have developed a histologic activity grading system designed to replace the commonly used modified-Lerner grading systems. Our system stratifies the low-level Lerner grade I category into 4 activity grade categories, based on the average frequency of apoptotic cells. The results are expressed as ordinal categories, GVHD of minimal, mild, moderate, severe histologic activity, or severe histologic activity with destruction (activity grades 1–5). In a retrospective study, 87 consecutive cases with 201 post-transplant specimens (median 48 days, range 18–1479 days) of stomach, duodenum, and colorectum, which had been activity graded at the time of the original diagnosis, were studied. Most of the biopsies diagnosed as GVHD were low grade—minimal (11%) or mild (71%) histologic activity. We hypothesized that the higher activity grades should be associated with more therapeutic intervention. The odds of increased therapy in the combined all-site specimens were increased as the activity grade increased [odds ratio (OR) = 2.9 (1.9–4.5), p=<.0001]. Thus, our grading system was validated. To investigate whether the activity grade was associated with therapy within the formerly undivided Lerner grade I category, the analysis was restricted to these 174 all-site specimens. The validation result was similar [OR = 3.1 (1.3–7.2), p=.009]. This result interestingly suggests that there is useful information hidden in the Lerner grade I category which could potentially guide immediately actionable treatment decisions. This histologic activity grade system has been in use at our institution for over 2 years, with good acceptance.
登录
查看更多内容
影响因子：
6.4
作者：
Liapis, George;Boletis, John;Delladetsima, Ioanna
通讯作者：
Delladetsima, Ioanna
影响因子：
20.3
作者：
Leisenring, Wendy M.;Martin, Paul J.;McDonald, George B.
通讯作者：
McDonald, George B.
影响因子：
6.2
作者：
GLUCKSBERG, H;STORB, R;THOMAS, ED
通讯作者：
THOMAS, ED
影响因子：
3.1
作者：
Cheung, Dae Young;Kim, Jin Il;Kang, Chang Suk
通讯作者：
Kang, Chang Suk
影响因子：
9.3
作者：
Cruz-Correa, M;Poonawala, A;Lee, LA
通讯作者：
Lee, LA