Chronic GvHD-associated serositis and pericarditis

Abstract

Serositis is a rare manifestation of chronic GvHD (cGvHD). No risk factors or laboratory changes associated with this syndrome have been recognized to date, and outcomes have not been described in a large series. We searched our institutional database for patients undergoing allogeneic hematopoietic cell transplant identified as having serositis or pericarditis. Laboratory studies from prior to diagnosis, at diagnosis and post diagnosis of serositis, as well as outcomes from invasive procedures were included. Twenty patients met criteria for cGvHD-associated serositis, and all but three patients had a prior diagnosis of cGvHD. Fifteen were male, and the complication occurred in the setting of immunosuppressant taper in 12 cases. Ten patients required invasive interventions, including pericardial window or stripping. A significant increase in blood monocytes and decrease in serum albumin were identified at diagnosis compared with pre-diagnosis. Out of 20 patients, 17 were treated with steroids, with 12 demonstrating a complete response. These data suggest that cGvHD-associated serositis occurs mainly in the setting of treated as opposed to de novo cGvHD and biomarkers associated with the syndrome include a decrease in albumin and an increase in absolute monocyte count. Outcome data from larger series are required to better understand the optimal management of this rare complication.

Incidence, etiology, and outcome of pleural effusions in allogeneic hematopoietic stem cell transplantation

“…Serositis type chronic GVHD, and BOOP were accountable for the second peak. The incidence of serositis type GVHD in our study was 1.23% which is close to 1.8% and 0.8% as reported by Leonard et al and Norkin et al, respectively . Both these studies primarily intended to investigate pericardial effusion or pericarditis as a manifestation of serositis, while our study was focused on exploring pleural effusion.…”

Encapsulating peritoneal sclerosis in a patient after allogeneic hematopoietic stem cell transplantation: a case report

“…Serositis is recognized as inflammation of any of the serosal linings of the body. In a non-transplant setting, serosal inflammation can be caused by a variety of factors including infection, autoimmune disease, and malignant disease [2]. In the setting of HSCT, serositis is a well-recognized but rare manifestation of cGVHD-associated conditions [5].…”

“…In the setting of HSCT, serositis is a well-recognized but rare manifestation of cGVHD-associated conditions [5]. Evidence regarding serositis after allogeneic HSCT is limited to case reports and a small case series because of its low frequency, with an incidence of 1–2% [2, 6, 7]. Seber et al reported an association between unexplained effusions and acute and cGVHD [6].…”

“…Especially, the association with cGVHD was demonstrated because pericardial effusion or ascites developed late after allogeneic HSCT [7, 8]. Regarding treatment and outcomes, immunosuppressive therapy, such as corticosteroids, was reported to be effective and the prognosis was good with a median survival of 105 months [2, 7–9].…”

“…Serositis is inflammation of the linings of the heart, lung, and abdominal organs, and causes pericardial effusion, pleural effusion, and ascites, respectively. Serositis can be caused by many different factors and is recognized as one of the rarest forms of cGVHD following allogeneic HSCT [2].…”