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Early post-transplant contrast-enhanced abdominopelvic CT scan predicts the risk of subsequent acute GvHD

Bone Marrow Transplantation volume 51, pages 150–152 (2016)Cite this article

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Acute GVHD (aGvHD) remains a major complication of allo-SCT. The pathogenesis of aGvHD is related to damage to the gut epithelium (caused largely by cytotoxic conditioning), which results in host APC activation, followed by donor T-cell allo-activation and tissue injury.1 Lack of a sensitive predictor for aGvHD has precluded individualized GvHD prophylaxis. We attempted to develop a novel imaging-based risk prediction model based on the extent of intestinal damage identified on early post-transplant computed tomography (CT).

Twenty consecutive patients with hematological malignancies who underwent allo-SCT were prospectively enrolled (#NCT02117115, June–October 2014; Table 1). Patients >60 years old, those with known allergy to iodinated contrast material or creatinine clearance <60 ml/min were excluded. One standard abdominopelvic computed tomography (CT) scan was performed between days +7 and +14, using a biphasic contrast protocol in the mucosal and enteric phases. The preference for doing the CT during the period between days +7 and +14 post SCT was according to the previous data suggesting maximal gut damage about 2 weeks after initiation of conditioning.2, 3 The specific day chosen for the CT was based on logistical factors. CT scoring was based on six characteristics: vasa recta engorgement (yes: 1, no: 0), gallbladder fossa edema (yes: 1, no: 0), mesenteric edema (yes: 1, no: 0), gallbladder/biliary enhancement (none: 0, mild: 1, moderate: 2, severe: 3), bowel wall thickening/enhancement (none: 0, mild: 1, moderate: 2, severe: 3) and number of involved bowel loops (none: 0, one loop: 1, two loops: 2, three or more loops: 3). These characteristics were adopted from the radiology literature in various settings of bowel inflammation (enteritis and/or colitis) such as with chemotherapy,4 radiotherapy,5 infections,6 neutropenia7 and Crohn’s disease.8 For grading of small bowel wall thickening, normal, mild, moderate and severe were defined as <2 mm, 2–3 mm, 3–5 mm and >5 mm, respectively. Acceptable colon wall thickness on CT depends on the degree of bowel distension.9 For grading of wall thickening in underdistended colon (<1.5 cm), normal, mild, moderate and severe were defined as <5 mm, 5–7 mm, 7–10 mm and >10 mm, respectively. For distended colon (>1.5 cm), grading was similar to the small bowel as described above. GvHD was diagnosed and graded according to the IBMTR criteria.10 All scans were reviewed on the day of CT by MFL, who remained blinded to clinical findings. All clinicians remained blinded to the CT score.

Table 1 Patient characteristics, acute GvHD and survival
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References

  1. Holtan SG, Pasquini M, Weisdorf DJ . Acute graft-versus-host disease: a bench-to-bedside update. Blood 2014; 124: 363–373.

    Article  CAS  Google Scholar 

  2. van der Velden WJ, Herbers AH, Feuth T, Schaap NP, Donnelly JP, Blijlevens NM . Intestinal damage determines the inflammatory response and early complications in patients receiving conditioning for a stem cell transplantation. PLoS ONE 2010; 5: e15156.

    Article  CAS  Google Scholar 

  3. van der Velden WJ, Herbers AH, Bruggemann RJ, Feuth T, Peter Donnelly J, Blijlevens NM . Citrulline and albumin as biomarkers for gastrointestinal mucositis in recipients of hematopoietic SCT. Bone Marrow Transplant 2013; 48: 977–981.

    Article  CAS  Google Scholar 

  4. Kelvin FM, Gramm HF, Gluck WL, Lokich JJ . Radiologic manifestations of small-bowel toxicity due to floxuridine therapy. AJR Am J Roentgenol 1986; 146: 39–43.

    Article  CAS  Google Scholar 

  5. Harb AH, Abou Fadel C, Sharara AI . Radiation enteritis. Curr Gastroenterol Rep 2014; 16: 383.

    Article  Google Scholar 

  6. Ash L, Baker ME, O'Malley CM Jr ., Gordon SM, Delaney CP, Obuchowski NA . Colonic abnormalities on CT in adult hospitalized patients with Clostridium difficile colitis: prevalence and significance of findings. AJR Am J Roentgenol 2006; 186: 1393–1400.

    Article  Google Scholar 

  7. Kirkpatrick ID, Greenberg HM . Gastrointestinal complications in the neutropenic patient: characterization and differentiation with abdominal CT. Radiology 2003; 226: 668–674.

    Article  Google Scholar 

  8. Paulsen SR, Huprich JE, Fletcher JG, Booya F, Young BM, Fidler JL et al. CT enterography as a diagnostic tool in evaluating small bowel disorders: review of clinical experience with over 700 cases. Radiographics 2006; 26: 641–657, discussion 657-662.

    Article  Google Scholar 

  9. Balthazar EJ . CT of the gastrointestinal tract: principles and interpretation. AJR Am J Roentgenol 1991; 156: 23–32.

    Article  CAS  Google Scholar 

  10. Rowlings PA, Przepiorka D, Klein JP, Gale RP, Passweg JR, Henslee-Downey PJ et al. IBMTR Severity Index for grading acute graft-versus-host disease: retrospective comparison with Glucksberg grade. Br J Haematol 1997; 97: 855–864.

    Article  CAS  Google Scholar 

  11. Goldberg J, Jacobsohn DA, Zahurak ML, Vogelsang GB . Gastrointestinal toxicity from the preparative regimen is associated with an increased risk of graft-versus-host disease. Biol Blood Marrow Transplant 2005; 11: 101–107.

    Article  Google Scholar 

  12. Liu D, Yan C, Xu L, Wang Y, Han W, Zhang X et al. Diarrhea during the conditioning regimen is correlated with the occurrence of severe acute graft-versus-host disease through systemic release of inflammatory cytokines. Biol Blood Marrow Transplant 2010; 16: 1567–1575.

    Article  Google Scholar 

  13. Johansson JE, Ekman T . Gut toxicity during hemopoietic stem cell transplantation may predict acute graft-versus-host disease severity in patients. Digest Dis Sci 2007; 52: 2340–2345.

    Article  Google Scholar 

  14. Levine JE, Braun TM, Harris AC, Holler E, Taylor A, Miller H et al. A prognostic score for acute graft-versus-host disease based on biomarkers: a multicenter study. Lancet Haematol 2015; 2: e21–e29.

    Article  Google Scholar 

  15. Fuji S, Kim SW, Fukuda T, Mori S, Yamasaki S, Morita-Hoshi Y et al. Preengraftment serum C-reactive protein (CRP) value may predict acute graft-versus-host disease and nonrelapse mortality after allogeneic hematopoietic stem cell transplantation. Biol Marrow Transplant 2008; 14: 510–517.

    Article  CAS  Google Scholar 

  16. Weissinger EM, Metzger J, Dobbelstein C, Wolff D, Schleuning M, Kuzmina Z et al. Proteomic peptide profiling for preemptive diagnosis of acute graft-versus-host disease after allogeneic stem cell transplantation. Leukemia 2014; 28: 842–852.

    Article  CAS  Google Scholar 

  17. Artz AS, Logan BR, Zhu X, Akpek G, Martino R, Gupta V et al. Pre-transplant C-reactive protein (CRP), ferritin and albumin as biomarkers to predict transplant related mortality (TRM) after allogeneic hematopoietic cell transplant (HCT). In: 56th American Society of Hematology Annual Meeting and Exposition. San Francisco, CA, 2014.

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Acknowledgements

This study was funded by a grant from Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO. We thank Shelly Meese for her assistance with protocol development, Mark Fiala for assistance with data collection and Rao Watson for providing the photomicrograph.

Author contributions

AR, MFL and AFC designed the study, interpreted the results and wrote the manuscript. AR collected the clinical data and analyzed the data. MFL collected the radiographic data.

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  1. Department of Medicine, Section of Bone Marrow Transplant and Leukemia, Washington University School of Medicine, St Louis, MO, USA

    A Rashidi & A F Cashen

  2. Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO, USA

    M F Lin

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  1. A Rashidi
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Correspondence to A F Cashen.

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Rashidi, A., Lin, M. & Cashen, A. Early post-transplant contrast-enhanced abdominopelvic CT scan predicts the risk of subsequent acute GvHD. Bone Marrow Transplant 51, 150–152 (2016). https://doi.org/10.1038/bmt.2015.232

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