Severe Gastrointestinal Bleeding After Hematopoietic Cell Transplantation, 1987–1997: Incidence, Causes, and Outcome

Abstract

The incidence of severe GI bleeding has declined significantly over the last decade because of prevention of viral and fungal infections and severe acute GVHD. However, severe bleeding after transplant remains a highly morbid event, particularly among patients with GVHD.

MxA expression in patients with viral infection after allogeneic stem cell transplantation

“…The clinical symptoms of various viral infectious diseases mimic those of acute graftversus-host disease (aGVHD), and it is difficult to discriminate between the two based upon symptoms. [1][2][3][4][5][6][7] However, it is important to do so because the treatment of these conditions is very different.…”

Efficacy of neodymium:YAG laser therapy for gastric antral vascular ectasia (GAVE) following hematopoietic cell transplant

“…1 The incidence of persistent, high-volume bleeding after transplant is 2.4% with a case fatality rate of 40%. 2 The most frequent cause of severe intestinal bleeding is refractory graft-versus-host disease (GVHD), a condition that is usually fatal. 2 A less common but treatable cause of severe bleeding is gastric antral vascular ectasia (GAVE), which appears to be caused by the transplant procedure itself, specifically the use of oral busulfan and the development of portal hypertension.…”

“…2 The most frequent cause of severe intestinal bleeding is refractory graft-versus-host disease (GVHD), a condition that is usually fatal. 2 A less common but treatable cause of severe bleeding is gastric antral vascular ectasia (GAVE), which appears to be caused by the transplant procedure itself, specifically the use of oral busulfan and the development of portal hypertension. 3,4 GAVE in the setting of hematopoietic cell transplant differs from the more common presentation which is often seen in patients who are elderly, have chronic liver disease, or have connective tissue disease.…”

Reversal of severe graft-versus-host disease after nonmyeloablative matched unrelated donor stem cell transplant by infusion of backup autologous peripheral blood stem cells

“…1,2 We report a successful use of infusion of autologous peripheral blood stem cells (ASC) to treat severe, refractory grade 4 aGVHD after a nonmyeloablative matched unrelated donor (MUD) transplant. A 55-year-old white female presented in December 2000 with pain and pathological fracture of the left humerus and was diagnosed with multiple myeloma.…”

“…4 The outcome of those developing steroid-refractory disease is poor, with 60-80% dying from GVHD-related causes. 1 Commonly used salvage agents include ATG, MMF, sirolimus, PUVA, and Daclizumab.…”