An investigation of the diagnostic, predictive, and prognostic impacts of three colonic biopsy grading systems for acute graft versus host disease

Abstract

Acute graft versus host disease (aGvHD) is an important, life-threatening complication after allogeneic hematopoietic stem cell transplantation (alloHSCT). To investigate the value of multiple simultaneous colon biopsies in improving diagnostic accuracy in patients with aGvHD, we retrospectively analyzed 157 patients after alloHSCT. The biopsies were evaluated individually using three established histological grading systems (Lerner, Sale, and Melson). The maximum, minimum, median, and mean histological aGvHD grades were calculated for each patient, and the results were correlated with the Glucksberg grade of clinical manifestation of GvHD, steroid therapy status, and outcome. We found that multiple colon biopsies enhanced diagnostic sensitivity. Moreover, higher histological grades correlated with steroid therapy initiation and refractoriness; the latter particularly occurred when advanced damage was present in all samples and healthy colon mucosa was reduced or absent. On multivariate analysis, the minimal Lerner and Glucksberg grades for intestinal aGvHD were significantly associated with steroid treatment failure. Ninety-nine patients died. The median survival was 285 days after the biopsies were taken. Fifteen patients died from relapse of their underling disorder and 84 from other causes, mostly infection (53 patients) and GvHD (14 patients). Multivariate analysis revealed a significant association between none-relapse mortality and the mean Lerner grade, minimum Melson grade, Glucksberg organ stage, and platelet counts. Thus, we found the Lerner system to be superior to the other grading methods in most instances and histologic evaluation of multiple simultaneously obtained biopsies from the colon to result in a higher diagnostic yield, which helps plan systemic steroid treatment while predicting treatment response and outcome.

Impact of the histologic grade of acute gastrointestinal graft-versus-host disease on outcomes in pediatric patients treated with allogeneic hematopoietic stem cell transplantation

“…Lerner et al, Melson et al, and Sale et al proposed histologic criteria that have been widely accepted and used by clinicians and pathologists ( 18 , 23 , 29 ). The method that is most consistent with clinical data regarding diagnostic accuracy, treatment response, and outcomes is known as the Lerner method, which assigns four grades according to the degree of epithelial cell damage ( 30 ). In this scoring system for histologic severity, cases in which only the apoptotic bodies are visible are classified as grade 1, and cases with other additional histologic findings related to epithelial damage are systematically classified as grades 2–4.…”

Development of graft-versus-host disease in a liver recipient. Clinical observations and literature review

“…Диагностика РТПХ основана на гистологическом исследовании пораженной ткани. Чаще всего диагноз ставится на основе материала из ЖКТ [20] или биопсии кожи [13,15]. Для дифференциального диагноза между различными дерматологическими заболеваниями могут быть использованы иммуногистохимические методы [21].…”

“…Индукция иммуносупрессии по стандартному протоколу: 20 У обеих наших пациенток имели место основные клинические проявления РТПХ (лихорадка, типичная сыпь, диарея, панцитопения). Диагноз в обоих случаях был подтвержден гистологически.…”

Origin and consequences of intestinal dysfunction following cytostatic chemotherapy and hematopoietic stem cell transplantation

“…The three adopted histopathological scales of gut aGvHD assessment were compared by Kreft et al [40]. A group of 157 patients with sufficient intestinal samples (>3 biopsies) was studied within 20-200 days after allo-HSCT.…”