Gastrointestinal Complications after Allogeneic Hematopoietic Stem Cell Transplant: A Multidisciplinary Approach with Early Endoscopic Evaluation

Authors

Giuseppe Tarantino^{1, *,} , Francesco Saraceni², Giorgia Mancini², Monica Poiani^{2, †}, Luca Maroni^1, , Gaia Goteri^3, , Ilaria Scortechini², Alessandro Fiorentini², Maria Vittoria Dubbini², Francesco Marini⁴, Luigi Daretti⁴, Marco Marzioni¹, Emanuele Bendia⁴, Antonio Benedetti¹, Attilio Olivieri²

¹Clinica di Gastroenterologia, Epatologia ed Endoscopia Digestiva d’Urgenza, Via Conca 71, Ospedali Riuniti Ancona, Italy

²Clinica Ematologica, Dipartimento di Medicina Interna, Ospedali Riuniti Ancona, Italy

³Anatomia Patologica, Dipartimento di Medicina Interna, Ospedali Riuniti Ancona, Italy

⁴Malattie dell’Apparato Digerente, Endoscopia Digestiva e Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti Ancona, Italy

^†

SC Ematologia A.S.U. Ospedale Maggiore, Trieste, Italy

^*Corresponding author. Email: giutar77@gmail.com

DOI

10.2991/chi.k.210826.001How to use a DOI?

Keywords

Gastro-intestinal complications (GICs) in allogeneic hematopoietic stem cell transplant (allo-HSCT); graft-versus-host-disease (GVHD); mucositis; endoscopy; intestinal histology

Abstract

Gastrointestinal complications (GICs) represent the major cause of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Differential diagnosis of GICs is of paramount importance since early and reliable identification of graft-versus-host disease (GVHD) is essential for a correct management of the patients. The aim of the present retrospective study was to evaluate the occurrence of GICs after allo-HSCT and to assess the diagnostic performance of a quick endoscopic and histological assessment in the differential diagnosis between GVHD and other GI conditions. Between January 2015 and August 2019, 122 consecutive patients receiving an allo-HSCT were managed by an interdisciplinary team, supported by a dedicated endoscopic service. Clinical, therapeutic, endoscopic and histological data were analyzed for each patient. Collectively, 94 of the patients developed GICs (77%). A moderate–severe mucositis was the most frequent complication, occurring in 79 patients (84%). Acute GI-GVHD was diagnosed in 35 patients (37% of whom with GICs) and 19 of them with a moderate–severe grade. Infective acute colitis developed in eight patients, mainly due to Clostridium difficile (CD) and Cytomegalovirus infections (8.5%). Rectal biopsy showed the highest sensitivity and specificity (80% and 100%, respectively). However, when biopsy procedures were guided by symptoms and performed on apparently intact mucosa, upper histology also provided a high negative predictive value (80%). Our multidisciplinary approach with a quick endoscopic/histologic investigation in the patients receiving an allo-HSCT and who suffered GICs could improve diagnostic and therapeutic management in this challenging setting.

Copyright

© 2021 International Academy for Clinical Hematology. Publishing services by Atlantis Press International B.V.

Open Access

This is an open access article distributed under the CC BY-NC 4.0 license (http://creativecommons.org/licenses/by-nc/4.0/).

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TY  - JOUR
AU  - Giuseppe Tarantino
AU  - Francesco Saraceni
AU  - Giorgia Mancini
AU  - Monica Poiani
AU  - Luca Maroni
AU  - Gaia Goteri
AU  - Ilaria Scortechini
AU  - Alessandro Fiorentini
AU  - Maria Vittoria Dubbini
AU  - Francesco Marini
AU  - Luigi Daretti
AU  - Marco Marzioni
AU  - Emanuele Bendia
AU  - Antonio Benedetti
AU  - Attilio Olivieri
PY  - 2021
DA  - 2021/09/23
TI  - Gastrointestinal Complications after Allogeneic Hematopoietic Stem Cell Transplant: A Multidisciplinary Approach with Early Endoscopic Evaluation
JO  - Clinical Hematology International
SP  - 161
EP  - 168
VL  - 3
IS  - 4
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.k.210826.001
DO  - 10.2991/chi.k.210826.001
ID  - Tarantino2021
ER  -