Gastrointestinal pathology of autologous graft-versus-host disease following hematopoietic stem cell transplantation: a clinicopathological study of 17 cases
| Autor: | William R. Drobyski, Christopher H. Cogbill, Richard A. Komorowski |
|---|---|
| Rok vydání: | 2011 |
| Předmět: |
Adult
Male Pathology medicine.medical_specialty Gastrointestinal Diseases medicine.medical_treatment Graft vs Host Disease Disease Hematopoietic stem cell transplantation Transplantation Autologous Pathology and Forensic Medicine Fatal Outcome Postoperative Complications medicine Humans Multiple myeloma Aged business.industry Lymphoma Non-Hodgkin Hematopoietic Stem Cell Transplantation Gastrointestinal pathology Middle Aged medicine.disease Lymphoma Transplantation Treatment Outcome surgical procedures operative Female Stem cell Multiple Myeloma Hematopathology business |
| Zdroj: | Modern Pathology. 24:117-125 |
| ISSN: | 0893-3952 |
| DOI: | 10.1038/modpathol.2010.163 |
| Popis: | Graft-versus-host disease is the major complication after allogeneic hematopoietic stem cell transplantation and is attributable to donor T-cell recognition of recipient alloantigens. In patients undergoing autologous hematopoietic stem cell transplantation in which there is no genetic disparity to induce an alloresponse, a syndrome similar to allogeneic graft-versus-host disease has been described. Designated as autologous graft-versus-host disease, it typically involves the skin and has reportedly caused little morbidity in this patient population. Recent data, however, suggest that autologous graft-versus-host disease can cause significant disease in the gastrointestinal tract, but its pathological spectrum of abnormalities and disease incidence are not well established. We report the development of autologous graft-versus-host disease following hematopoietic stem cell transplantation in 17 patients (15 with multiple myeloma) based on 388 autologous stem cell transplants carried out at our institution over a 6-year period. This represents a total incidence rate of 4% and among those transplanted for multiple myeloma, 6%. In all, 16 of the 17 patients had colonic biopsies performed for the diagnostic evaluation of persistent diarrhea. Biopsies in all 16 patients showed pathological evidence for graft-versus-host disease and were graded using standard grading criteria established for allogeneic graft-versus-host disease. Grades ranged from mild (grade 1/4) to severe (grade 4/4). Changes secondary to medication or infection were excluded. Responses to steroid and immunosuppressive therapy were variable but improved with continuing institutional experience. Outcomes ranged from a prompt, complete resolution of symptoms to death. Patients treated with autologous hematopoietic stem cell transplantation, particularly those with multiple myeloma, may develop a potentially life-threatening syndrome pathologically identical to allogeneic graft-versus-host disease. This diagnosis must be considered when interpreting biopsies from patients with gastrointestinal symptoms following autologous hematopoietic stem cell transplantation. |
| Databáze: | OpenAIRE |
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