Intestinal and Hepatic Complications of Human Bone Marrow Transplantation. Part II

McDonald, George B.; Shulman, Howard M.; Sullivan, Keith M.; Spencer, Gerald D.

doi:10.1016/0016-5085(86)91137-6

Cited by 184 publications

(75 citation statements)

References 219 publications

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“…Necrosis of the intestinal mucosa is typical of acute GVHD, but is unusual after day 100 and is not part of the chronic GVHD syndrome characterized by patchy fibrosis of the lamina propria and striking fibrosis of the submucosa and serosa extending from the stomach to the colon. 6 Moreover, in our patient colon biopsies showed no sign of acute or chronic GVHD.…”

Section: Discussionsupporting

confidence: 48%

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Bronchiolitis obliterans organizing pneumonia and ulcerative colitis after allogeneic bone marrow transplantation

Baron

Hermanne

Dowlati

et al. 1998

Bone Marrow Transplant

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Summary:A 37-year-old man with acute myeloblastic leukemia in first remission developed ulcerative colitis and bronchiolitis obliterans organizing pneumonia (BOOP) 7 months after bone marrow transplantation (BMT) from an HLA-matched brother who suffered from severe Crohn's disease. BOOP occurred 20 days after idiopathic interstitial pneumonia, in the context of severe ulcerative colitis. Lung and colon biopsies showed no signs of CMV infection or GVHD. The patient was treated with oral methylprednisolone 1 mg/kg/day and his clinical status and chest X-ray improved slowly. Remarkably, the symptoms of colitis also resolved with prednisone therapy and he is now symptom-free. We hypothesize that ulcerative colitis may have been transmitted from donor to recipient (adoptive autoimmunity) and that it was complicated by BOOP. However, other factors such as CMV may have contributed to the occurrence of BOOP. Keywords: allogeneic bone marrow transplantation; autoimmune diseases; ulcerative colitis; BOOP; adoptive autoimmunity Bronchiolitis obliterans organizing pneumonia (BOOP) is a rare cause of diffuse infiltrative lung disease. It may be idiopathic or occur in association with infections, drugs or miscellaneous neoplastic or inflammatory diseases. The first case of BOOP following bone marrow transplantation (BMT) was described in 1990. 1 Since then, six additional cases of BMT-associated BOOP have been reported (Table 1), including two successive episodes in a single patient undergoing two BMT procedures. 2-4 BOOP has also been described in several patients with inflammatory bowel disease. 5 We report a new case of BMT-associated BOOP which developed in the recipient of a marrow transplant from a donor who suffered from Crohn's disease. As the patient simultaneously developed ulcerative colitis and BOOP about 6 months after BMT, this observation could Correspondence: Dr Y Beguin, University of Liège, Department of Hematology, CHU Sart-Tilman, 4000 Liège, Belgium Received 15 August 1997; accepted 11 November 1997 constitute a case of adoptive autoimmunity in which transmission from donor to recipient of inflammatory bowel disease could have contributed to the pathogenesis of BMTassociated BOOP. Case reportThe patient, a 37-year-old man with acute myeloblastic leukemia in first remission, received a genotypically HLAidentical BMT from his brother in March 1995. The donor was negative for cytomegalovirus (CMV) on serology but had suffered from severe Crohn's disease for the past 15 years, which was treated with sulfasalazine and azathioprine. The latter was stopped 3 weeks before the transplant. The recipient was positive for CMV. Pre-transplant pulmonary function tests were normal. Conditioning consisted of cytarabine 12 g/m 2 , cyclophosphamide 120 mg/kg and single dose total body irradiation (TBI) 8 Gy. Graft-versushost disease (GVHD) prophylaxis was carried out with short methotrexate and cyclosporine (CsA).The initial post-transplant course was complicated by grade 1 acute skin GVHD that resolved after increasing t...

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Section: Discussionsupporting

confidence: 48%

“…Ulcerative colitis following BMT may also have a toxic origin but exceptionally so after day 100 post-BMT. 6 The first reported case of BMT-related BOOP followed CMV interstitial pneumonia. 1 Moreover, ulcerative colitis may also be due to viral (such as CMV or HSV) infections.…”

Section: Discussionmentioning

confidence: 99%

Bronchiolitis obliterans organizing pneumonia and ulcerative colitis after allogeneic bone marrow transplantation

Baron

Hermanne

Dowlati

et al. 1998

Bone Marrow Transplant

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“…It is generally accepted that, while acute GVHD can involve the whole GI tract, chronic GI GVHD mostly affects the oesophagus, sparing the lower GI tract (McDonald et al, 1986) leading to desquamation of the oesophageal mucosa with submucosal fibrosis (Iqbal et al, 2000). Damage to the oesophageal mucosa eventually leads to symptoms such as dysphagia and odynophagia.…”

Section: Gastrointestinal Tractmentioning

confidence: 99%

Optimal management of chronic graft‐versus‐host disease in children

Jacobsohn

2010

Br J Haematol

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SummaryChronic graft-versus-host disease (GVHD) is a major complication after allogeneic haematopoietic stem cell transplantation (HSCT). Not only is it the major cause of late mortality in HSCT patients, but it also accounts for significant morbidity. Much of the literature on chronic GVHD has focused on adults. Chronic GVHD is of major importance in children, especially since they have years to live following the complications of chronic GVHD and its therapy. The goal is to review incidence, manifestations, and therapies, especially when applicable to the paediatric population.

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“…12,13 High levels of LDH are also seen with liver damage which is common in the first few weeks after BMT. 14,15 Similarly, most other laboratory and clinical abnormalities seen with thrombotic microangiopathy are not specific to thrombotic microangiopathy.…”

mentioning

confidence: 99%

Red cell fragmentation (schistocytosis) after bone marrow transplantation

Zomas

Sašo

Powles

et al. 1998

Bone Marrow Transplant

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Summary:Red cell fragmentation is often the earliest sign of thrombotic microangiopathy. Days +14, +28 and +42 blood films from 58 allograft and 32 autograft recipients were reviewed blind to determine the incidence and severity of schistocytosis (the number of fragmented red cells per 1000 red cells expressed as a percentage). Schistocytosis was graded as mild (Ͻ1%), moderate (1-1.9%) or severe (у2%). Schistocytes were seen in 99% of day 14 films (0.1-3.0%, median 0.4%), 97% of day 28 films (0.1-3.2%, median 0.4%), and 98% of day 42 films (0.1-4.3%, median 0.5%). Nine patients (10%) had severe fragmentation and 20 patients (22%) had moderate fragmentation at some time or the other. The difference in the extent of fragmentation between the days was not significant. Allogeneic BMT was associated with more extensive fragmentation than autologous transplantation on day 28 (P = 0.008) and day 42 (P = 0.02). Age, conditioning regimen and diagnosis had no influence. None of the patients followed-up for 6 months after transplant developed full-blown thrombotic microangiopathy. The occasional patient showing mild clinical and laboratory features of hemolysis responded well to adjustment of fluid balance and cyclosporine dose where applicable. Our data indicate that mild red cell fragmentation is a common morphologic finding after transplantation with no clinical significance in the absence of other clinical and laboratory findings suggestive of thrombotic microangiopathy, although patients with moderate or severe fragmentation should be monitored closely.

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Intestinal and Hepatic Complications of Human Bone Marrow Transplantation. Part II

Cited by 184 publications

References 219 publications

Bronchiolitis obliterans organizing pneumonia and ulcerative colitis after allogeneic bone marrow transplantation

Bronchiolitis obliterans organizing pneumonia and ulcerative colitis after allogeneic bone marrow transplantation

Optimal management of chronic graft‐versus‐host disease in children

Red cell fragmentation (schistocytosis) after bone marrow transplantation

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