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Severe intestinal graft-versus-host disease following autologous stem cell transplantation

Bone Marrow Transplantation volume 38, pages 391–392 (2006)Cite this article

A 61-year-old woman was originally diagnosed with stage IVB follicular lymphoma in 1981 when she presented with lymphadenopathy, fever and night sweats. She was treated with BCNU (carmustine), cyclophosphamide, vincristine and prednisone, and achieved a complete remission. She relapsed in 1994 and over the next decade was treated several times with chemotherapy and localized radiation for recurrent disease. In August 2004, an excisional biopsy of an enlarged cervical lymph node revealed disease transformation into a large B-cell lymphoma. After two cycles of high-dose ifosfamide, etoposide and rituximab, peripheral blood progenitor cells were mobilized. She then received conditioning therapy with BNCU, etoposide, cytarabine and melphalan (BEAM). On day 0, 4.6 × 106/kg CD34+ autologous cells were infused. Granulocyte recovery occurred on day +10, and platelet recovery on day +15. On day +11, she developed diarrhoea, and was treated with metronidazole for a presumptive diagnosis of Clostridium difficile colitis, despite multiple negative toxin assays. She was discharged on day +15, but the diarrhoea worsened, was >1500 ml on most days, and over the next 6 weeks she lost 15 pounds. Neither skin rash, nor liver function abnormalities developed.

Over the course of the subsequent 3 months, steroids were tapered and the patient remained well. She denied abdominal pain or fever. However, when the prednisone was reduced to 5 mg/day, she again developed severe diarrhoea with eight watery, voluminous bowel movements daily, associated with tenesmus and anorexia. Repeat colonoscopy showed numerous, non-bleeding edematous ulcers throughout the colon. Biopsies did not reveal an increase in apoptotic bodies, in contrast to the prior biopsy specimens. Cultures of stool and of colonic mucosa were again negative. There was no skin rash, and liver function tests were normal. Prednisone was increased to 30 mg daily, with a rapid and marked improvement in her symptoms within 1 week. She remains well and without evidence of disease 14 months after her auto hematopoietic cell transplantation (HCT). Prednisone was successfully tapered approximately 10 months after the second episode of auto GVHD.

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Authors and Affiliations

  1. Section of Hematology/Oncology, University of Chicago, Chicago, IL, USA

    J Kline, K van Besien & A Artz

  2. Section of Gastroenterology, University of Chicago, Chicago, IL, USA

    J Nathanson

  3. Department of Medicine, University of Chicago, Chicago, IL, USA

    J Kline, K van Besien, J Nathanson & A Artz

  4. Department of Pathology, University of Chicago, Chicago, IL, USA

    A Noffsinger

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  1. J Kline
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Correspondence to A Artz.

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Kline, J., van Besien, K., Nathanson, J. et al. Severe intestinal graft-versus-host disease following autologous stem cell transplantation. Bone Marrow Transplant 38, 391–392 (2006). https://doi.org/10.1038/sj.bmt.1705460

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