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

Giuseppe Tarantino; Francesco Saraceni; Giorgia Mancini; Monica Poiani; Luca Maroni; Gaia Goteri; Ilaria Scortechini; Alessandro Fiorentini; Maria Vittoria Dubbini; Francesco Marini; Luigi Daretti; Marco Marzioni; Emanuele Bendia; Antonio Benedetti; Attilio Olivieri

doi:10.2991/chi.k.210826.001

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

Clin Hematol Int. 2021 Sep 23;3(4):161-168. doi: 10.2991/chi.k.210826.001. eCollection 2021 Dec.

Authors

Affiliations

¹ Clinica di Gastroenterologia, Epatologia ed Endoscopia Digestiva d'Urgenza, Via Conca 71, Ospedali Riuniti Ancona, Italy.
² Clinica Ematologica, Dipartimento di Medicina Interna, Ospedali Riuniti Ancona, Italy.
³ Anatomia Patologica, Dipartimento di Medicina Interna, Ospedali Riuniti Ancona, Italy.
⁴ Malattie dell'Apparato Digerente, Endoscopia Digestiva e Malattie Infiammatorie Croniche Intestinali, Ospedali Riuniti Ancona, Italy.

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.

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