Institute of Pathology, University Medical Center Mainz, Mainz, Germany.
3rd Medical Department, Hematology, Oncology and Pneumology, University Medical Center Mainz, Germany.
Leuk Lymphoma. 2023 Feb;64(2):433-439. doi: 10.1080/10428194.2022.2142056. Epub 2022 Nov 6.
Graft-versus-host disease (GvHD) involving the intestine is a threat to patients after allogeneic hematopoietic stem cell transplantation (alloHSCT). We evaluated biopsies from different sites of the upper gastrointestinal tract (GIT) of 97 patients after alloHSCT. Forty-six patients with clinical symptoms consistent with upper GI GvHD revealed histological features of GvHD in the esophagus, stomach, and/or duodenum. Biopsies of the duodenum and esophagus were significantly more sensitive for signs of GvHD than those of the gastric antrum or corpus. The histological features of GvHD were significantly correlated with the endoscopic findings of ulcers, erosion, atrophy, and white plaques; however, the sensitivity and specificity of the latter were low. In univariate analysis, overall mortality was significantly associated with histological GvHD signs in all four sites. Nonrelapse mortality was associated with histologic GvHD features in the antrum only. Regarding GvHD diagnosis, biopsies of the upper gastrointestinal tract should include the duodenum and/or esophagus.
移植物抗宿主病（GVHD）是异基因造血干细胞移植（alloHSCT）后患者的威胁。我们评估了 97 例 alloHSCT 后上消化道（GIT）不同部位的活检。46 例有上 GI GvHD 临床症状的患者在食管、胃和/或十二指肠中显示出 GvHD 的组织学特征。十二指肠和食管的活检对 GvHD 迹象的敏感性明显高于胃窦或胃体。GvHD 的组织学特征与内镜下溃疡、糜烂、萎缩和白斑块的发现显著相关；然而，后者的敏感性和特异性较低。在单变量分析中，所有四个部位的组织学 GvHD 征象与总死亡率显著相关。非复发死亡率与仅在胃窦的组织学 GvHD 特征相关。关于 GvHD 诊断，上消化道活检应包括十二指肠和/或食管。
