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Association between histopathological alterations and diarrhea severity in acute intestinal graft-versus-host disease.

Abstract Gastrointestinal (GI) acute graft-versus-host disease (aGVHD) remains one of the most important complications of allogeneic hematopoietic cell transplantation (allo-HCT). The diagnosis of this complication is largely dependent on clinical symptoms, but GI biopsies are warranted in most cases, due to the multitude of potential causes that coexist in patients with a clinical suspicion of this complication. In addition, several lines of evidence support that the GI is not only a target organ in aGVHD, but also a key mediator of the pathogenesis of this condition. Controversy exists on whether histopathological findings are associated with clinical severity. Crypt loss is a relatively straightforward histological finding of GI aGVHD, whose presence has been associated with disease severity in a previous study.In order to independently validate this association, we retrospectively evaluated all histological changes from 25 patients with confirmed GI aGVHD who underwent allo-HCT in our center from 2008 to 2014. Clinical, laboratory, and histological data were obtained from the medical records and pathological reports. All GI biopsies were reviewed by 2 investigators blinded to clinical data, who classified GI aGVHD according to the presence of severe crypt loss.The proportion of patients with grades I-II and III-IV aGVHD patients in our population were 45.5% and 54.5%, respectively. The most common histological alterations were isolated apoptotic bodies, present in 80% of colon biopsies with aGVHD. Severe crypt loss, corresponding to grades III-IV aGVHD was associated with higher stool volumes (P = .02) and increased diarrhea duration (P = .02), but not with response to steroids or mortality.In this study, we independently validated that the presence of severe crypt loss, a reliable and simple parameter to grade the extension of GI aGVHD, is associated with disease severity in GI aGVHD.
PMID
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Authors

Mayor MeshTerms

Diarrhea

Graft vs Host Disease

Hematopoietic Stem Cell Transplantation

Keywords
Journal Title medicine
Publication Year Start




PMID- 29742694
OWN - NLM
STAT- MEDLINE
DCOM- 20180515
LR  - 20180515
IS  - 1536-5964 (Electronic)
IS  - 0025-7974 (Linking)
VI  - 97
IP  - 19
DP  - 2018 May
TI  - Association between histopathological alterations and diarrhea severity in acute 
      intestinal graft-versus-host disease.
PG  - e0600
LID - 10.1097/MD.0000000000010600 [doi]
AB  - Gastrointestinal (GI) acute graft-versus-host disease (aGVHD) remains one of the 
      most important complications of allogeneic hematopoietic cell transplantation
      (allo-HCT). The diagnosis of this complication is largely dependent on clinical
      symptoms, but GI biopsies are warranted in most cases, due to the multitude of
      potential causes that coexist in patients with a clinical suspicion of this
      complication. In addition, several lines of evidence support that the GI is not
      only a target organ in aGVHD, but also a key mediator of the pathogenesis of this
      condition. Controversy exists on whether histopathological findings are
      associated with clinical severity. Crypt loss is a relatively straightforward
      histological finding of GI aGVHD, whose presence has been associated with disease
      severity in a previous study.In order to independently validate this association,
      we retrospectively evaluated all histological changes from 25 patients with
      confirmed GI aGVHD who underwent allo-HCT in our center from 2008 to 2014.
      Clinical, laboratory, and histological data were obtained from the medical
      records and pathological reports. All GI biopsies were reviewed by 2
      investigators blinded to clinical data, who classified GI aGVHD according to the 
      presence of severe crypt loss.The proportion of patients with grades I-II and
      III-IV aGVHD patients in our population were 45.5% and 54.5%, respectively. The
      most common histological alterations were isolated apoptotic bodies, present in
      80% of colon biopsies with aGVHD. Severe crypt loss, corresponding to grades
      III-IV aGVHD was associated with higher stool volumes (P = .02) and increased
      diarrhea duration (P = .02), but not with response to steroids or mortality.In
      this study, we independently validated that the presence of severe crypt loss, a 
      reliable and simple parameter to grade the extension of GI aGVHD, is associated
      with disease severity in GI aGVHD.
FAU - da Costa, Loredana Nilkenes Gomes
AU  - da Costa LNG
AD  - Faculty of Medical Sciences.
AD  - Federal University of Piaui, Parnaiba, Piaui, Brazil.
FAU - Costa-Lima, Carolina
AU  - Costa-Lima C
AD  - Faculty of Medical Sciences.
AD  - Hematology and Hemotherapy Center, University of Campinas, Campinas, SP.
FAU - de Meirelles, Luciana Rodrigues
AU  - de Meirelles LR
AD  - Faculty of Medical Sciences.
FAU - Carvalho, Rita B
AU  - Carvalho RB
AD  - Faculty of Medical Sciences.
FAU - Colella, Marcos Paulo
AU  - Colella MP
AD  - Hematology and Hemotherapy Center, University of Campinas, Campinas, SP.
FAU - Aranha, Francisco Jose Penteado
AU  - Aranha FJP
AD  - Hematology and Hemotherapy Center, University of Campinas, Campinas, SP.
FAU - Vigorito, Afonso Celso
AU  - Vigorito AC
AD  - Hematology and Hemotherapy Center, University of Campinas, Campinas, SP.
FAU - De Paula, Erich Vinicius
AU  - De Paula EV
AD  - Faculty of Medical Sciences.
AD  - Hematology and Hemotherapy Center, University of Campinas, Campinas, SP.
LA  - eng
PT  - Journal Article
PT  - Observational Study
PL  - United States
TA  - Medicine (Baltimore)
JT  - Medicine
JID - 2985248R
SB  - AIM
SB  - IM
MH  - Biopsy/methods
MH  - Brazil
MH  - *Diarrhea/diagnosis/etiology/pathology
MH  - Female
MH  - Gastrointestinal Tract/*pathology
MH  - *Graft vs Host Disease/diagnosis/etiology/pathology
MH  - *Hematopoietic Stem Cell Transplantation/adverse effects/methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Severity of Illness Index
MH  - Statistics as Topic
MH  - Transplantation, Homologous/adverse effects/methods
EDAT- 2018/05/10 06:00
MHDA- 2018/05/16 06:00
CRDT- 2018/05/10 06:00
PHST- 2018/05/10 06:00 [entrez]
PHST- 2018/05/10 06:00 [pubmed]
PHST- 2018/05/16 06:00 [medline]
AID - 10.1097/MD.0000000000010600 [doi]
AID - 00005792-201805110-00013 [pii]
PST - ppublish
SO  - Medicine (Baltimore). 2018 May;97(19):e0600. doi: 10.1097/MD.0000000000010600.