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Post-Transplant Events

Serial intestinal endoscopic examinations of patients with persistent diarrhea after allo-SCT

Bone Marrow Transplantation volume 47, pages 694–699 (2012)Cite this article

Abstract

Gastrointestinal (GI) GVHD after allo-SCT is diagnosed on the basis of symptoms and findings in endoscopic mucosal biopsy specimens. However, GI symptoms often persist despite treatment and whether a second endoscopy may be helpful in determining the most suitable therapy is not established. We identified 31 patients with persistent diarrhea who underwent more than one endoscopic study. All cases underwent serial microbiological stool analysis and CMV-detecting assays on serum and biopsies. Of the 31 initial GI biopsies, 20 (64.5%) were classified as GVHD, two (6.5%) as GVHD with CMV, four (13%) as non-CMV infection, and five (16%) as normal or unspecific. The second GI biopsies were diagnostic of GVHD in nine cases (29%), GVHD simultaneously with CMV infection in four (13%), regenerative changes post-GVHD in five (16%), CMV infection in four (13%), and normal or unspecific in nine (29%). In 22 of the 31 patients (71%), the histological findings of the second/third endoscopic biopsies differed from the findings of the first endoscopy and led to a therapy change in 77%. In conclusion, serial GI endoscopies are of reliable diagnostic value and can impact on therapeutic decision-making for patients with persistent diarrhea after allo-SCT.

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References

  1. Przepiorka D, Smith TL, Folloder J, Khouri I, Ueno NT, Mehra R et al. Risk factors for acute graft-versus-host disease after allogeneic blood stem cell transplantation. Blood 1999; 94: 1465–1470.

    CAS  PubMed  Google Scholar 

  2. Cox GJ, Matsui SM, Lo RS, Hinds M, Bowden RA, Hackman RC et al. Etiology and outcome of diarrhea after marrow transplantation: a prospective study. Gastroenterology 1994; 107: 1398–1407.

    Article  CAS  Google Scholar 

  3. Wu D, Hockenberry DM, Brentnall TA, Baehr PH, Ponec RJ, Kuver R et al. Persistent nausea and anorexia after marrow transplantation. Transplantation 1998; 66: 1319–1324.

    Article  CAS  Google Scholar 

  4. Parfitt JR, Jayakumar S, Driman DK . Mycophenolate mofetil-related gastrointestinal mucosal injury; variable injury patterns, including graft-versus-host disease-like changes. Am J Surg Pathol 2008; 32: 1367–1372.

    Article  Google Scholar 

  5. Snover DC . Mucosal damage simulating acute graft-versus-host reaction in cytomegalovirus colitis. Transplantation 1985; 39: 669–670.

    Article  CAS  Google Scholar 

  6. Bombi JA, Nadal A, Carreras E, Ramirez J, Muñoz J, Rozman C et al. Assessment of histopathologic changes in the colonic biopsy in acute graft-versus-host disease. Am J Clin Pathol 1995; 103: 690–695.

    Article  CAS  Google Scholar 

  7. MacMillan ML, Weisdorf DJ, Wagner JE, DeFor TE, Burns LJ, Ramsay NK et al. Response to 443 patients to steroids as primary therapy for acute graft-versus-host disease: comparison of grading systems. Biol Blood Marrow Transplant 2002; 8: 387–394.

    Article  CAS  Google Scholar 

  8. Degg HJ . How I treat refractory acute GVHD. Blood 2001; 109: 4119–4126.

    Article  Google Scholar 

  9. Ljungman P, de la Camara R, Cordonier C, Einsele H, Engelhard D, Reusser P et al. Management of CMV, HHV-6, HHV-7 and Kaposi-sarcoma herpesvirus (HHV-8) infections in patients with haematological malignances and after SCT. Bone Marrow Transplant 2008; 42: 227–240.

    Article  CAS  Google Scholar 

  10. Gallucci GB, Sale GE, McDonald GB, Epstein R, Shulman HM, Thomas ED . The fine structure of human rectal epithelium in acute graft-versus-host disease. Am J Surg Pathol 1982; 6: 293–305.

    Article  CAS  Google Scholar 

  11. Sale GE, Shulman HM, McDonald GB, Thomas ED . Gastrointestinal graft-versus-host disease in man: a clinicopathologic study of the rectal biopsy. Am J Surg Pathol 1979; 3: 291–299.

    Article  CAS  Google Scholar 

  12. Washington K, Jagasia M . Pathology of graft-versus-host disease in the gastrointestinal tract. Hum Pathol 2009; 40: 909–917.

    Article  Google Scholar 

  13. Ponec RJ, Hackman RC, McDonald GB . Endoscopic and histologic diagnosis of intestinal graft-versus-host disease after marrow transplantation. Gastrointest Endosc 1999; 49: 612–621.

    Article  CAS  Google Scholar 

  14. Terdiman JP, Linker CA, Ries CA, Damon LE, Rugo HS, Ostroff JW . The role of endoscopic evaluation in patients with suspected intestinal graft-versus-host disease after allogeneic bone marrow transplantation. Endoscopy 1996; 28: 680–685.

    Article  CAS  Google Scholar 

  15. Ross WA, Ghosh S, Dekovich AA, Liu S, Ayers G, Cleary KR et al. Endoscopic biopsy diagnosis of acute gastrointestinal graft-versus-host disease: rectosigmoid biopsies are more sensitive than upper gastrointestinal biopsies. Am J Gastroenterol 2008; 103: 982–989.

    Article  Google Scholar 

  16. Cruz-Correa M, Poonawala A, Abraham SC, Wu TT, Zahurak M, Vogelsang G et al. Endoscopic findings predict the histologic diagnosis in gastrointestinal graft-versus-host disease. Endoscopy 2002; 34: 808–813.

    Article  CAS  Google Scholar 

  17. Roy J, Snover D, Weisdorf S, Mulvahill A, Filipovich A, Weisdorf D . Simultaneous upper and lower endoscopic biopsy in the diagnosis of intestinal graft-versus-host disease. Transplantation 1991; 51: 642–646.

    Article  CAS  Google Scholar 

  18. Piñana JL, Martino R, Barba P, Margall N, Roig MC, Valcárcel D et al. Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-center experience. Bone Marrow Transplant 2010; 45: 534–542.

    Article  Google Scholar 

  19. Martin PJ, McDonald GB, Sanders JE, Anasetti C, Appelbaum FR, Deeg HJ et al. Increasingly frequent diagnosis of acute gastrointestinal graft-versus-host disease after allogeneic hematopoietic cell transplantation. Biol Blood Marrow Transplant 2004; 10: 320–327.

    Article  Google Scholar 

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Authors and Affiliations

  1. Hematology Department, Stem Cell Transplantation Unit, Institute of Hematology and Oncology, Barcelona, Spain

    C Martínez, M Rosales, X Calvo, F Fernández-Avilés, L Rosiñol, M Rovira, E Carreras & Á Urbano-Ispízua

  2. Pathology Department, Biomedical Diagnostic Center, Barcelona, Spain

    M Cuatrecasas & L Rodriguez-Carunchio

  3. Gastroenterology Department, Hospital Clínic, University of Barcelona, Barcelona, Spain

    J Llach

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  1. C Martínez
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  2. M Rosales
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  3. X Calvo
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Correspondence to C Martínez.

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Martínez, C., Rosales, M., Calvo, X. et al. Serial intestinal endoscopic examinations of patients with persistent diarrhea after allo-SCT. Bone Marrow Transplant 47, 694–699 (2012). https://doi.org/10.1038/bmt.2011.143

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  • DOI: https://doi.org/10.1038/bmt.2011.143

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