Etiology and outcome of diarrhea after marrow transplantation: A prospective study

Cox, George J.; Matsui, Shigeru; Lo, Roger S.; Hinds, Mary S.; Bowden, Raleigh A.; Hackman, Robert C.; Meyer, Walter G.; Mori, Motomi; Tarr, Phillip I.; Oshiro, Lyndon S.; Ludert, Juan E.; Meyers, Joel D.; McDonald, George B.

doi:10.1016/0016-5085(94)90542-8

Cited by 270 publications

(195 citation statements)

References 48 publications

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“…Acute GVHD and intestinal infection have been the major causes of diarrhea after the resolution of regimen-related intestinal toxicity. 16 Except for infection, severe diarrhea has been treated as intestinal GVHD in many occasions. However, such diarrhea is often refractory to treatment for acute GVHD.…”

Section: Introductionmentioning

confidence: 99%

Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy

Inamoto

Ito²,

Suzuki

et al. 2009

Bone Marrow Transplant

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Section: Introductionmentioning

confidence: 99%

Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy

Inamoto

Ito²,

Suzuki

et al. 2009

Bone Marrow Transplant

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“…4 While these symptoms may be caused by acute graft-versushost disease (GVHD), they may also be attributable to chemoradiation toxicity, medication side effects, or a variety of bacterial, fungal, viral and parasitic infections. 2,5 Endoscopic findings in GVHD, linked to stage of disease, range from normal mucosa to erythema, edema, erosions, ulcerations and mucosal sloughing. [5][6][7] In a retrospective study of patients undergoing upper gastrointestinal (UGI) endoscopy and biopsy between days 20 and 100 following HSCT, no significant differences in symptoms or endoscopic appearance were observed between patients with or without UGI GVHD.…”

Section: Introductionmentioning

confidence: 99%

“…2,5 Endoscopic findings in GVHD, linked to stage of disease, range from normal mucosa to erythema, edema, erosions, ulcerations and mucosal sloughing. [5][6][7] In a retrospective study of patients undergoing upper gastrointestinal (UGI) endoscopy and biopsy between days 20 and 100 following HSCT, no significant differences in symptoms or endoscopic appearance were observed between patients with or without UGI GVHD. 8 Given the nonspecific symptoms and endoscopic findings of acute GVHD and the significant side effects of immunosuppressive medications used to treat GVHD, a histologic diagnosis should be sought before treatment is initiated.…”

Section: Introductionmentioning

confidence: 99%

Prospective endoscopic evaluation for gastrointestinal graft-versus-host disease: determination of the best diagnostic approach

Thompson

Salzman

Steinhauer

et al. 2006

Bone Marrow Transplant

126

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The best endoscopic diagnostic strategy for gastrointestinal (GI) graft-versus-host disease (GVHD) is unknown. Over a 48-month period, all patients with unexplained diarrhea at risk for acute gastrointestinal GVHD were prospectively identified. Acute GVHD was defined as symptoms and histologic evidence of GVHD occurring within 100 days of transplant or donor lymphocyte infusion (DLI). Colonoscopy was performed with multiple biopsies of the ileum, right colon and rectosigmoid colon. Next, upper endoscopy with duodenal and random gastric biopsies of both antrum and body were performed. All biopsies were evaluated for GVHD by an experienced GI pathologist. Over the study period, 24 patients (mean age 37 years; 62.5% male) were evaluated. The median time from transplantation or DLI was 30.5 days. The biopsy site with the highest yield was the distal colon (82%). A combination of upper endoscopy with sigmoidoscopy and colonoscopy with ileal biopsies were equivalent (B94%). In patients with diarrhea at risk for GVHD, biopsies of the distal colon had the highest diagnostic yield suggesting the importance of sigmoidoscopy and biopsy. Colonoscopy and ileoscopy or flexible sigmoidoscopy plus upper endoscopy had the highest diagnostic yields.

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“…Although relapse is the most frequent cause of transplant failure, the antileukemic effect of conditioning regimens, administered to eradicate leukemia and suppress host hematopoiesis, is not likely to be further increased without increasing toxicity, and possibly jeopardizing the final outcome, since many patients still die of TRT, despite supportive therapy and improvements in infectious disease management in the last decade. 1,[12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Since appropriate tools for measuring toxicity would allow comparison of different conditioning regimens, Bearman and collaborators 12 retrospectively registered toxicity reported in eight organs in a series of 195 leukemic patients, transplanted in Seattle up to 1988. The four-grade classification proposed by the Seattle team was restricted to conditioning regimen side-effects and excluded events related to infections, acute graft-versus-host disease (aGVHD) and drugs used for supportive therapy.…”

mentioning

confidence: 99%

Transplant-related toxicity and mortality: an AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia

Balduzzi

Valsecchi

Silvestri

et al. 2002

Bone Marrow Transplant

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Summary:Hematopoietic stem cell transplantation can cure highrisk acute leukemia (AL), but the occurrence of nonleukemic death is still high. The AIEOP conducted a prospective study in order to assess incidence and relationships of early toxicity and transplant-related mortality (TRM) in a pediatric population. Between 1990 and 1997 toxicities reported in eight organs (central nervous system, heart, lungs, liver, gut, kidneys, bladder, mucosa) were classified into three grades (mild, moderate, severe) and prospectively registered for 636 consecutive children who underwent autologous (216) or allogeneic (420) transplantation, either from an HLA compatible related (294), or alternative (126) donor in 13 AIEOP transplant centers. Overall, 47% of the patients are alive in CR (3-year EFS: 45.2%, s.e.: 2.1), 19% died in CR at a median of 60 days (90-day TRM: 14.3%, s.e.: 1.4), 34% relapsed. Toxicity of any organ, but mucosa and gut, was positively correlated with early death; moderate and severe toxicity to heart, lungs, liver and kidneys significantly increased early TRM, with estimated relative risks of 9.1, 5.5, 2.7 and 2.8, respectively, as compared to absent or mild toxicity. Patients with grade III-IV aGVHD experienced more than double (56% vs 19%) TRM than patients with grade 0-II aGVHD. A higher cumulative toxicity score, estimating the impact of toxicity on TRM, was significantly associated with transplantation from an alternative donor. Quantitative assessment allowed us to describe the

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Etiology and outcome of diarrhea after marrow transplantation: A prospective study

Cited by 270 publications

References 48 publications

Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy

Clinicopathological manifestations and treatment of intestinal transplant-associated microangiopathy

Prospective endoscopic evaluation for gastrointestinal graft-versus-host disease: determination of the best diagnostic approach

Transplant-related toxicity and mortality: an AIEOP prospective study in 636 pediatric patients transplanted for acute leukemia

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