Gastrointestinal radiographic features of human graft-vs.-host disease

Fisk, John D.; Shulman, HM; Rr, Greening; McDonald, G. A.; Ge, Shengfang; Thomas, E. Donnall

doi:10.2214/ajr.136.2.329

Cited by 66 publications

(32 citation statements)

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“…67 In some patients, involvement of the small intestine by acute GVHD may lead to permanent damage, resulting in mechanical obstruction, diarrhea, stasis syndrome, and malabsorption. 46,68,69 Obstructive lung disease…”

Section: Gi Tractmentioning

confidence: 99%

Chronic graft-versus-host disease: clinical manifestation and therapy

Ratanatharathorn

Ayash

Lazarus

et al. 2001

Bone Marrow Transplant

231

149

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Summary:Chronic graft-versus-host disease (GVHD) is a major cause of morbidity and mortality in long-term survivors of allogeneic stem cell transplantation. The immunopathogenesis of chronic GVHD is, in part, TH-2 mediated, resulting in a syndrome of immunodeficiency and an autoimmune disorder. The most important risk factor for chronic GVHD is prior history of acute GVHD and strategies that prevent acute GVHD also decrease the risk of chronic GVHD. Other important risk factors are the use of a non-T cell-depleted graft, and older age of donor and recipient. Whether recipients of peripheral blood stem cells are at increased risk of chronic GVHD remains unsettled. There are no known pharmacologic agents which can specifically prevent development of chronic GVHD. Agents which have efficacy in the treatment of autoimmune disorders have been utilized as therapy for established chronic GVHD and are associated with response rates of 20% to 80%. Most responses are confined to skin, soft tissue, oral mucosa and occasionally liver. Bronchiolitis obliterans responds infrequently to therapy and is associated with a dismal prognosis. Newer, promising therapeutic strategies under investigation include thalidomide, photopheresis therapy, anti-tumor necrosis factor and B cell depletion with anti-CD20 monoclonal antibody. Bone Marrow Transplantation (2001) 28, 121-129.

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Section: Gi Tractmentioning

confidence: 99%

Chronic graft-versus-host disease: clinical manifestation and therapy

Ratanatharathorn

Ayash

Lazarus

et al. 2001

Bone Marrow Transplant

231

149

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“…52 Reliable non-invasive procedures to evaluate its extension and treatment response are still lacking. 3,4 We hypothesized that CEUS could specifically detect MVC at the onset of GVHD and during its treatment. Our hypothesis partly derives from the observations that intestinal biopsies during acute GVHD show an increased microvessel circulation 53 and that graft-vs-host reactions are associated with increased neovascularization.…”

Section: Discussionmentioning

confidence: 99%

“…Diarrhea volume is generally used to determine the severity of the intestinal involvement, but its clinical reliability is highly limited. 3,4 Overall, non-invasive specific and sensitive techniques to diagnose intestinal GVHD (I-GVHD), to evaluate treatment response and to guide the duration of immunosuppression are still lacking. Standard transabdominal ultrasonography (US) has already been used for its diagnosis and clinical follow-up, [5][6][7] and, more widely, in a variety of other intestinal diseases, [8][9][10] including inflammatory bowel diseases.…”

Section: Introductionmentioning

confidence: 99%

Prospective qualitative and quantitative non-invasive evaluation of intestinal acute GVHD by contrast-enhanced ultrasound sonography

Benedetti

Bruno

McDonald

et al. 2013

Bone Marrow Transplant

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Intestinal acute GVHD (I-aGVHD) is a life-threatening complication after allografting. Non-invasive bed-side procedures to evaluate extension and treatment response are still lacking. We hypothesized that, during I-aGVHD, contrast-enhanced ultrasound sonography (CEUS) could detect microcirculation changes (MVC) of the bowel wall (BW) and help to monitor treatment response. We prospectively employed CEUS in 83 consecutive patients. Of these, 14 patients with biopsy-proven intestinal GVHD (I-GVHD) were defined as the study group, whereas 16 patients with biopsy-proven stomach GVHD (U-GVHD) without intestinal symptoms, 6 normal volunteers and 4 patients with neutropenic enterocolitis were defined as the control group. All patients were evaluated with both standard ultrasonography (US) and CEUS at the onset of intestinal symptoms, during clinical follow-up and at flare of symptoms. Standard US revealed BW thickening of multiple intestinal segments, useful to determine the extension of GVHD. CEUS showed MVC, which correlated with GVHD activity, treatment response, and predicted flare of intestinal symptoms. US and CEUS findings were superimposable at diagnosis and in remission. CEUS was, however, more sensitive and specific to identify subclinical activity in patients with clinical relevant improvement. These findings were not observed in the control groups. CEUS is a non-invasive, easily reproducible bed-side tool useful to monitor I-aGVHD.

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“…Several authors have described the clinical manifestations of gut GVHD (3)(4)(5)(6)(7)(8)(9). Voluminous diarrhea is a prominent manifestation in acute gut GVHD, the volumeof which corresponds to the extent of mucosal damage (3 thickening of the small bowel, colon and mesenteric wall (4).…”

Section: Discussionmentioning

confidence: 99%

“…Voluminous diarrhea is a prominent manifestation in acute gut GVHD, the volumeof which corresponds to the extent of mucosal damage (3 thickening of the small bowel, colon and mesenteric wall (4). Radiologic features reported were as follows; rapid transit time of passing the contrast material (5), absence of haustration (5, 6), formation of ulcerative lesion (6) and thickening of colonic wall (7). Histologically, crypt cell degeneration, and inflammatory cell infiltration are found in humans (8,9), with the appearance ofapoptotic cells in mice (10).…”

Section: Discussionmentioning

confidence: 99%

Acute Graft-versus-Host Disease of the Gut.

et al. 1995

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A 28-year-old man with acute promyelocytic leukemia at first early relapse received HLAmatched allogenic bone marrow transplantation (BMT) at first early relapse. Cyclosporin A and methotrexate were administered at conventional doses as a prophylaxis for graft-versus-host disease (GVHD). He presented with severe bloody diarrhea on day 87 after BMT.Examination of the lower gastrointestinal tract revealed diffuse mucosal change of inflammation. A diagnosis of late onset of acute gut GVHD was made, in the absence of other manifestations such as skin and liver involvement. A further survey is needed to clarify the incidence and the pathogenesis of atypical gutGVHD. (Internal Medicine 34: 751-755, 1995)

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Gastrointestinal radiographic features of human graft-vs.-host disease

Cited by 66 publications

References 0 publications

Chronic graft-versus-host disease: clinical manifestation and therapy

Chronic graft-versus-host disease: clinical manifestation and therapy

Prospective qualitative and quantitative non-invasive evaluation of intestinal acute GVHD by contrast-enhanced ultrasound sonography

Acute Graft-versus-Host Disease of the Gut.

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