[623] Gastrointestinal Pathology of Autologous Graft-Versus-Host Disease Following Hematopoietic Progenitor Cell Transplantation

CH Cogbill, WR Drobyski, RA Komorowski. Medical College of Wisconsin, Milwaukee, WI

Background: Graft-versus-host disease (GVHD) is the major complication after allogeneic hematopoietic progenitor cell transplantation (HPCT) and is attributable to donor T-cell recognition of recipient alloantigens. In patients undergoing autologous HPCT where there is no genetic disparity to induce an alloresponse, a syndrome similar to allogeneic GVHD has been described. This syndrome, termed autologous GVHD, has been reported to cause minimal morbidity in this patient population. Recent data, however, indicate that autologous GVHD can cause significant disease in the gastrointestinal tract, although the disease incidence and pathological spectrum of this complication are uncertain.
Design: Case series, retrospective review.
Results: In this study, we report the development of autologous GVHD involving the gastrointestinal tract in sixteen patients treated with HPCT. Fifteen patients had multiple myeloma and one patient had mediastinal diffuse large B-cell lymphoma. Based on 538 autologous stem cell transplants done at our institution over a 9½ year period, this represents a total incidence rate of 3.0%. Of multiple myeloma patients undergoing autologous transplantation, the incidence was 4.2%. Fifteen of the sixteen patients had colonic biopsies performed for persistent diarrhea and showed pathological evidence for GVHD using standard criteria for allogeneic GVHD. The histological grade of GVHD ranged from mild (grade 1/4) to severe (grade 4/4). Changes secondary to medication or infection were excluded. Involvement of the skin and liver was variable. Responses to steroid and immunosuppressive therapy ranged from full resolution of symptoms to death secondary to complications of the immunosuppressive therapy.

Patient Characteristics

Diagnosis	GVHD grade	Biopsy date*
MM	1	+195
MM	4	+26
MM	2	+41
MM	4	+13
MM	1	+25
MM	3	+14
MM	2	+14
Mediastinal DLBCL	2	+15
MM	1	+16
MM	2	+14
MM	3-4	+15
MM	4	+16
MM	2	+27
MM	3	+15
MM	3	+14
MM	4	+14
MM = multiple myeloma; DLBCL = diffuse large B-cell lymphoma
*Days following autologous transplant

Conclusions: Patients treated with autologous HPCT, particularly those with multiple myeloma, can develop a potentially life-threatening syndrome pathologically identical to allogeneic GVHD. This diagnosis should be considered in the differential diagnosis when interpreting changes in biopsies from autologous HPCT patients with gastrointestinal symptoms.
Category: Gastrointestinal

Monday, March 22, 2010 1:00 PM

Poster Session II # 85, Monday Afternoon