Graft-Versus-Host Disease of the Upper Gastrointestinal Tract After an Autologous Stem Cell Transplant

Abstract

Graft-versus-host disease (GVHD) in recipients of autologous stem cell transplantation (SCT) is less common compared to recipients of allogeneic SCT, but its existence has been well documented. Similarly, the diarrheal component of the disease is highlighted when discussing its gastrointestinal (GI) manifestations, with less emphasis given to upper GI symptoms like nausea and vomiting. We present a case illustrating the upper GI tract signs and symptoms of GVHD after autologous SCT, and emphasize that prompt treatment can rapidly improve morbidity and prevent disease progression.

Autologous Gastrointestinal Graft-vs-Host Disease in a Patient With Multiple Myeloma and Hematopoietic Stem Cell Transplantation

“…2 The diagnosis is confirmed histologically with apoptotic epithelial cells or crypt cell dropout with lymphocytic infiltrates. 8 Several studies have shown that patients with MM are at a higher risk of developing auto-GVHD compared with other patients undergoing auto-HSCT. 9 Furthermore, it has been suggested that auto-GVHD in MM patients can follow a more severe course and may not respond to steroids as desired.…”

Incidence of chronic renal injury in patients undergoing autologous stem cell transplant therapy

“…13,37 The phenomenon of autologous GVHD has been reported and the syndrome occurs in up to 10% of autograft recipients. 38,39 Moreover, 6% of patients with documented membranous glomerulonephritis after HSCT had undergone autografts. In such cases, it is hypothesised that the pathophysiology underlying the renal injury relates to posttransplantation immune dysregulation resulting in T-and B-cell targeting of podocyte antigens.…”

“…In the allogeneic transplant setting, membranous glomerulonephritis has been increasingly considered to be a manifestation of chronic GVHD involving the kidneys 13,37 . The phenomenon of autologous GVHD has been reported and the syndrome occurs in up to 10% of autograft recipients 38,39 . Moreover, 6% of patients with documented membranous glomerulonephritis after HSCT had undergone autografts.…”

Isolated Gastrointestinal Graft versus Host Disease in a Patient of Multiple Myeloma after Autologous Hematopoietic Stem Cell Transplantation

“…Amongst isolated case reports, Fidler, et al described a case of auto-GVHD with skin and gastrointestinal manifestations in a patient with MM, who ultimately deteriorated and expired despite steroid therapy [5]. Recently, Barbash, et al described a case of spontaneous GI GVHD with predominant upper GI involvement in a patient of multiple myeloma who underwent autologous HSCT [6].…”