Colon biopsies for evaluation of acute graft-versus-host disease (A-GVHD) in allogeneic bone marrow transplant patients

BMC Gastroenterology

Richard Komorowski³  Varghese George¹  Bal Kampalath³  Paul F Lindholm³  Farrukh Ghazala³  Ganesh Shidham²  Chung-Che Chang³  Vinod B Shidham³ 

[1] Division of Biostatistics, Medical College of Wisconsin, Milwaukee, WI, USA;Division of Nephrology, Medical College of Wisconsin, Milwaukee, WI, USA;Department of Pathology, Medical College of Wisconsin, Milwaukee, WI, USA

关键词: GVHD;    NSAIDs;    CMV;    apoptosis;    bone marrow transplant;    colon biopsy;    Acute graft-versus-host disease;   

Others  :  1215897
DOI  :  10.1186/1471-230X-3-5

 received in 2002-12-30, accepted in 2003-03-27,  发布年份 2003

【 摘 要 】

Background

Proper histomorphological interpretation of intestinal acute graft versus host disease (A-GVHD) associated with allogeneic bone marrow transplantation (BMT) is critical for clinical managaement. However, studies methodically evaluating different histomorphological features of A-GVHD are rare.

Methods

Colonic biopsies from 44 allogeneic BMT patients having biopsy-proven cutaneous A-GVHD were compared with colon biopsies from 48 negative controls.

Results

A-GVHD showed intra-cryptal apoptosis in 91% and pericryptal apoptosis in adjacent lamina propria in 70% (p < 0.002). Nonspecific apoptosis along the surface epithelium was observed in all groups with comparable frequency. The number of apoptotic cells in mucosa were approximately four times (5.3 per 10 HPF) the negative controls (p < 0.002) in A-GVHD group. 48% of cases with A-GVHD showed decreased number of lymphocytes in lamina propria. Some features, including intraepithelial lymphocytes in surface or crypt epithelium; and neutrophils, eosinophils, and edema in lamina propria, did not demonstrate significant difference in A-GVHD and negative controls. Pericryptal apoptosis, dilated crypts, irregular distribution of crypts, decreased lymphocytes, increased microvessel network, focal fibrosis, presence of muciphages, reactive changes in surface epithelium with mucin depletion, mucosal ulceration, and/or reduced mucosal thickness showed higher association with A-GVHD group.

Conclusions

Intracyptal apoptosis is a reliable indicator of A-GVHD. Its diagnostic significance was improved if intracyptal apoptosis was associated with features which were observed more frequently in A-GVHD group as mentioned above.

【 授权许可】

   
2003 Shidham et al; licensee BioMed Central Ltd. This is an Open Access article: verbatim copying and redistribution of this article are permitted in all media for any purpose, provided this notice is preserved along with the article's original URL.

【 图 表 】

Figure 1.

Figure 2.

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