To explore influence factors of steroid-resistant acute gastrointestinal graft versus host disease (aGVHD) in allogeneic hematopoietic stem cell transplantation.

A retrospective analysis was conducted on 20 patients with aGVHD who underwent allogeneic hematopoietic stem cell transplantation in our hospital from January 2012 to December 2019. Patients were divided into steroid-sensitive group (13 cases) and steroid-resistant group (20 cases) . Patients' gender, age, diagnosis as well as pre-transplant MRD, transplantation type, donor's age, donor-recipient relationship, ABO blood type, mononuclear cell number, CD34⁺ cell number, CD3⁺ cells in graft, neutrophil and platelet engraft time, CMV and EB infection, aGVHD onset time in gastrointestinal tract, of the above factors' relationship with steroid-resistant gastrointestinal aGVHD were analyzed by univariate logistics regression.

Among 20 patients with gastrointestinal aGVHD, 7 patients were steroid-resistant. When acute GVHD occurs less than 1 month , the risk of steroid resistance was increased (OR = 13.500, 95 ﹪CI = 1.197 ~ 152.211, P = 0.035) . Gender, age, diagnosis, pre-transplant MRD, transplant type, donor age, donor-recipient relationship, donor-recipient ABO blood group, transfused monocytes, CD34⁺ cells, CD3⁺ cells, neutrophils and platelet implantation time, CMV and EB virus infection have no effect in steroid resistance (P > 0.05) . Logistic regression analysis showed that aGVHD onset time in gastrointestinal tract was negatively correlated with steroid-resistant. 7 patients with steroid-resistant gastrointestinal aGVHD were treated with CD25 monoclonal antibody while 2 patients died after ineffective treatment. One year overall survival and progression free survival rates of the steroid-sensitive patients were 64﹪and 28﹪, and one year overall survival and progression free survival rates of the steroid-resistant patients were 52﹪ and 32﹪. There was no significant difference of 1-years OS and PFS between two groups (P > 0.05) .

Steroid-resistant gastrointestinal aGVHD was related to its onset time after allogeneic hematopoietic stem cell transplantation. The earlier it occurs, the more likely it is to be steroid resistance.