A Case Report of Gastrointestinal Graft‐Versus‐Host Disease Following Autologous Hematopoietic Cell Transplantation

1NYU, New York, NY

Meeting: Hospital Medicine 2014, March 24-27, Las Vegas, Nev.

Abstract number: 675

Case Presentation:

A 54 year‐old man with a history of multiple myeloma presented with ten weeks of nausea and vomiting with associated anorexia and a 50‐pound weight loss. His symptoms began five days after receiving an autologous stem‐cell transplant for treatment of his multiple myeloma. He had no history of prior gastrointestinal illnesses, denied diarrhea, and had tolerated chemotherapy in the past with minimal nausea and vomiting. Of note, the patient did not develop nausea and vomiting with the conditioning chemotherapy regimen of busulfan, bortezomib and melphalan given one week before his autologous stem cell transplant. Further, he had tolerated prior chemotherapy regimens with minimal nausea and vomiting. He appeared cachetic with a body mass index of 19.7 but had no abnormalities on abdominal exam.

His nausea and vomiting were refractory to a combination of oral and intravenous anti‐emetics in addition to appetite stimulants. Esophagogastroduodenoscopy showed severe gastroparesis, esophagitis, and no source of anatomic obstruction. Biopsies of the gastric and duodenal mucosa showed mild graft versus host disease (GVHD) in the duodenum. A skin biopsy confirmed the diagnosis of mild GVHD. The patient was initiated on Prednisone 60mg by mouth daily for GVHD, and his symptoms of nausea, vomiting, and anorexia resolved within 2 days of therapy. The patient has since maintained good appetite and has remained symptom‐free on subsequent follow up evaluation.

Discussion:

While many cases of autologous graft‐versus‐host disease (GVHD) reported to date are limited to the skin, recent data suggests that autologous GVHD can cause significant disease in the GI tract. Auto‐GVHD involving the GI tract is typically characterized by profuse, watery diarrhea; nausea; vomiting; abdominal cramping; or bleeding. Endoscopy of the GI tract shows edema, mucosal sloughing, or bleeding. Biopsy specimens have proven to be the most sensitive modality for the diagnosis of GI tract GVHD. Systemic corticosteroids are the mainstay of treatment for acute GVHD. High dose prednisone at 1‐2 mg/kg per day for 7 to 14 days followed by gradual dose reduction is the standard initial treatment. Auto‐GVHD is considered to be a milder condition than allo‐GVHD, and patients often respond to corticosteroid monotherapy. Patients who do not respond to steroids are at increased risk from mortality associated with uncontrolled GVHD, and often require prolonged steroid courses or the use of salvage therapy.

Conclusions:

This case illustrates that when patients who have undergone auto‐HCT present with a significant GI tract illness, one should consider autologous GVHD on the differential diagnosis when potential infectious etiologies have been ruled out. Early intervention immunosuppressive therapy can prove significant in recovery from this potentially fatal condition

To cite this abstract:

White C, Shoucri S, Prasad P, Xu R, Mazumder A. A Case Report of Gastrointestinal Graft‐Versus‐Host Disease Following Autologous Hematopoietic Cell Transplantation. Abstract published at Hospital Medicine 2014, March 24-27, Las Vegas, Nev. Abstract 675. Journal of Hospital Medicine. 2014; 9 (suppl 2). https://www.shmabstracts.com/abstract/a-case-report-of-gastrointestinal-graftversushost-disease-following-autologous-hematopoietic-cell-transplantation/. Accessed September 19, 2019.

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