Severe autologous GVHD after hematopoietic progenitor cell transplantation for multiple myeloma

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

“…Case series reporting this entity have reported mortality as high as 50%. In the case series by Drobyski, et al out of the 2 cases with isolated GI GVHD, 1 died [3]. Six patients out of 12 with isolated GI GVHD, could not be salvaged in the study by Cogbill [8].…”

“…In another case series reported by Drobyski, et al there was a 2% incidence of autologous GVHD in patients of multiple myeloma and among these patients, five developed a clinical syndrome consistent with GI GVHD. Four of these 5 patients ultimately expired due to complications attributed to steroid-refractory GI GVHD [3]. 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].…”

“…Cogbill, et al demonstrated isolated GI GVHD in 12 patients out which 6 cases expired [8]. The case series by Drobyski, et al had 2 cases of isolated GI GVHD [3]. Krishna, et al demonstrated spontaneous recurrent GI GVHD after a tandem autologous transplant for multiple myeloma with predominant lower GI symptoms and excellent response to enteric-coated budesonide therapy [9].…”

“…It is seen more commonly in patients of multiple myeloma (MM) than in other haematological malignancies [3]. In particular, the risk for autologous GVHD is higher in patients undergoing tandem transplantation for MM (12%) than in those undergoing a single session of transplantation (0.9%) [3].…”

“…GVHD following autologous HSCT is uncommon and its incidence has been reported to vary from 2-13% [3,4]. It is seen more commonly in patients of multiple myeloma (MM) than in other haematological malignancies [3].…”