Clinical Hematology International

In Press, Corrected Proof, Available Online: 23 September 2021

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

Authors
Giuseppe Tarantino1, *, ORCID, Francesco Saraceni2, Giorgia Mancini2, Monica Poiani2, , Luca Maroni1, ORCID, Gaia Goteri3, ORCID, 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
Corresponding Author
Giuseppe Tarantino
Received 15 April 2021, Accepted 26 August 2021, Available Online 23 September 2021.
DOI
https://doi.org/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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Journal
Clinical Hematology International
Publication Date
2021/09/23
ISSN (Online)
2590-0048
DOI
https://doi.org/10.2991/chi.k.210826.001How to use a DOI?
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/).

Cite this article

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
SN  - 2590-0048
UR  - https://doi.org/10.2991/chi.k.210826.001
DO  - https://doi.org/10.2991/chi.k.210826.001
ID  - Tarantino2021
ER  -