Endoscopic criteria for colonic mucosal damage in children with suspected acute graft-versus-host disease after allogeneic hematopoietic stem cell transplantation

Abstract

Today, results of allogeneic hematopoietic stem cell transplantation (allo-HSCT) are very encouraging but nevertheless, 25–75% of patients still develop complications, and mortality rates reach as high as 10–19%. Two major complications of allo-HSCT are graft-versus-host disease (GVHD) and viral infections. The diagnosis of intestinal GVHD remains a challenge. Incorrect interpretation of gastrointestinal lesions may lead to grave consequences. The development of endoscopic criteria for GVHD is a major focal point in foreign literature. In our study, we included 33 patients aged 1–17 years with signs of enterocolitis and suspected isolated intestinal GVHD who had received allo-HSCT at the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of Russia between 2020 and 2023. The study was approved by the Independent Ethics Committee and the Scientific Council of the Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology of Ministry of Healthcare of Russia. All the patients underwent white-light colonoscopy with i-scan and, if necessary, chromoendoscopy; as well as colonic mucosal biopsy for further histopathological evaluation and intestinal infection testing. Statistical analysis was performed using the IBM SPSS Statistics 23 software. Viruses were identified in the colonic mucosal samples of 84.8% of the patients. The most common pathogens were: HHV-6 (in 50% of the cases), norovirus (46.4%) and adenovirus (35.7%). The high incidence of colonic viral infections in the children with GVHD is likely the result of virus reactivation during intensive immunosuppressive therapy following allo-HSCT. In 78.8% of the study patients, the colonic mucosa had orange-peel appearance, which led us to consider such mucosal changes to be the main criterion for the endoscopic diagnosis of GVHD in children after allo-HSCT, regardless of the presence or absence of viral infections. Our study demonstrated a fairly high effectiveness of the chromoendoscopy advanced imaging technology. Further research on ways to improve methods for GVHD differential diagnosis is required.