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Surgical resection as definitive treatment for refractory GVHD of the colon

Bone Marrow Transplantation volume 47, pages 1366–1367 (2012)Cite this article

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Allogeneic hematopoietic SCT is a potentially curative treatment for patients with high-risk hematological malignancies. The major complication associated with this form of therapy is GVHD. GVHD is due to the alloactivation of donor T-cells, which results in the production of proinflammatory cytokines, and recruitment of other immune effector cells resulting in tissue injury.1 GVHD typically affects a fairly restricted set of organs (that is, skin, liver and gastrointestinal tract) during the acute phase, whereas tissue involvement is much more extensive in chronic GVHD where nearly all organs can be affected.2

Because of the multi-system nature of the disease, systemic treatments are invariably used to control generalized inflammation. Primary first-line treatment of GVHD is usually with systemic corticosteroids, which typically results in responses in ∼50% of patients.3, 4 For those patients who fail to respond there is no standard second-line therapy that has been validated in well-designed clinical trials. The majority of patients are treated with other systemic immune-suppressive therapies that target T-cell activation pathways or inflammatory cytokine production.5 Owing to the widespread tissue involvement that is a characteristic of most patients with GVHD, surgery is generally not considered.

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Authors and Affiliations

  1. Bone Marrow Transplant Program, Medical College of Wisconsin, Milwaukee, WI, USA

    R F Cornell, J Palmer & W R Drobyski

  2. Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

    R Komorowski

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  1. R F Cornell
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  2. J Palmer
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  3. R Komorowski
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  4. W R Drobyski
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Correspondence to W R Drobyski.

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Cornell, R., Palmer, J., Komorowski, R. et al. Surgical resection as definitive treatment for refractory GVHD of the colon. Bone Marrow Transplant 47, 1366–1367 (2012). https://doi.org/10.1038/bmt.2012.15

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