Skip to main content

Advertisement

SpringerLink
Log in

Bowel wall thickness is a strong predictor of steroid-refractory acute graft-versus-host disease with gut involvement after allo-HSCT

  • Original Article
  • Published:
International Journal of Hematology Aims and scope Submit manuscript

Abstract

Objective

Acute graft-versus-host-disease (aGVHD) develops in 10–80% of allo-HSCT patients. More than half of all aGVHD cases are refractory to first-line therapy with steroids. We hypothesized that bowel wall thickness at the time of aGVHD diagnosis could be an early sign of steroid-refractory aGVHD with gut involvement.

Method

Our prospective study included 85 patients with hematological malignancies who had undergone allo-HSCT. We used an inexpensive, widespread and simple method of transabdominal ultrasonography to examine bowel wall thickness in patients suspected to have gut aGVHD.

Results

Descending colon wall thickness was significantly greater in patients with gut aGVHD later found to be steroid-refractory than in patients with steroid-sensitive gut aGVHD, with AUC—0.73 (95% CI 0.58–0.87, p = 0.013). We showed that bowel wall thickness could predict the steroid-refractoriness of aGVHD.

Conclusion

Transabdominal ultrasonography could be used as a marker of steroid-refractory aGVHD with gut involvement after allo-HSCT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Passweg JR, Baldomero H, Peters C, Gaspar HB, Cesaro S, Dreger P, et al. Hematopoietic SCT in Europe: data and trends in 2012 with special consideration of pediatric transplantation. Bone Marrow Transpl. 2014;49:744–50.

    Article  Google Scholar 

  2. Shokouhi S, Bray S, Bakhtiyari S, Sayehmiri K, Alimoghadam K, Ghavamzadeh A. Effects of aGVHD and cGVHD on survival rate in patients with acute myeloid leukemia after allogeneic stem cell transplantation. Int J Hematol Oncol Stem cell Res. 2015;9:112–21.

    PubMed  PubMed Central  Google Scholar 

  3. Gratwohl A, Hermans J, Apperley J, Arcese W, Bacigalupo A, Bandini G, et al. Acute graft-versus-host disease: grade and outcome in patients with chronic myelogenous leukemia. Working Party Chronic Leukemia of the European Group for Blood and Marrow Transplantation. Blood. 1995;86:813–8.

    Article  CAS  Google Scholar 

  4. Garnett C, Apperley JF, Pavlů J. Treatment and management of graft-versus-host disease: improving response and survival. Ther Adv Hematol. 2013;4:366–78.

    Article  CAS  Google Scholar 

  5. Zhang H, Chen R, Cheng J, Jin N, Chen B. Systematic review and meta-analysis of prospective studies for ECP treatment in patients with steroid-refractory acute GVHD. Patient Prefer Adherence. 2015;9:105–11.

    PubMed  PubMed Central  Google Scholar 

  6. Martin PJ, Schoch G, Fisher L, Byers V, Anasetti C, Appelbaum FR, et al. A retrospective analysis of therapy for acute graft-versus-host disease: initial treatment. Blood. 1990;76:1464–72.

    Article  CAS  Google Scholar 

  7. Weisdorf D, Haake R, Blazar B, Miller W, McGlave P, Ramsay N, et al. Treatment of moderate/severe acute graft-versus-host disease after allogeneic bone marrow transplantation: an analysis of clinical risk features and outcome. Blood. 1990;75:1024–30.

    Article  CAS  Google Scholar 

  8. Deeg HJ. How I treat refractory acute GVHD. Blood. 2007;109:4119–26.

    Article  CAS  Google Scholar 

  9. Xhaard A, Rocha V, Bueno B, de Latour RP, Lenglet J, Petropoulou A, et al. Steroid-refractory acute GVHD: lack of long-term improved survival using new generation anticytokine treatment. Biol Blood Marrow Transpl. 2012;18:406–13.

    Article  CAS  Google Scholar 

  10. Arai S, Margolis J, Zahurak M, Anders V, Vogelsang GB. Poor outcome in steroid-refractory graft-versus-host disease with antithymocyte globulin treatment. Biol Blood Marrow Transpl. 2002;8:155–60.

    Article  Google Scholar 

  11. Calabrese E. Bowel ultrasound for the assessment of Crohn’s disease. Gastroenterol Hepatol (N Y). 2011;7:107–9.

    Google Scholar 

  12. Rosenbaum DG, Conrad MA, Biko DM, Ruchelli ED, Kelsen JR, Anupindi SA. Ultrasound and MRI predictors of surgical bowel resection in pediatric Crohn disease. Pediatr Radiol. 2016;47:55–64.

    Article  Google Scholar 

  13. Przepiorka D, Weisdorf D, Martin P, Klingemann HG, Beatty P, Hows J, et al. 1994 consensus conference on acute GVHD grading. Bone Marrow Transpl. 1995;15:825–8.

    CAS  Google Scholar 

  14. Haber HP, Benda N, Fitzke G, Lang A, Langenberg M, Riethmüller J, et al. Colonic wall thickness measured by ultrasound: striking differences in patients with cystic fibrosis versus healthy controls. Gut. 1997;40:406–11.

    Article  CAS  Google Scholar 

  15. Luznik L, Donnell PVO, Symons HJ, Chen AR, Susan M, Zahurak M, et al. HLA-haploidentical bone marrow transplantation for hematologic malignancies using nonmyeloablative conditioning and high-dose. Posttransplant Cyclophosphamide Biol Blood Marrow Transpl. 2009;14:641–50.

    Article  Google Scholar 

  16. Luznik L, Bolaños-Meade J, Zahurak M, Chen AR, Smith BD, Brodsky R, et al. High-dose cyclophosphamide as single-agent, short-course prophylaxis of graft-versus-host disease. Blood. 2010;115:3224–30.

    Article  CAS  Google Scholar 

  17. Storb R, Thomas ED, Weiden PL, Buckner CD, Clift RA, Fefer A, et al. Aplastic anemia treated by allogeneic bone marrow transplantation: a report on 49 new cases from Seattle. Blood. 1976;48:817–41.

    Article  CAS  Google Scholar 

  18. Storb R, Deeg HJ, Pepe M, Appelbaum F, Anasetti C, Beatty P, et al. Methotrexate and cyclosporine versus cyclosporine alone for prophylaxis of graft-versus-host disease in patients given HLA-identical marrow grafts for leukemia: long-term follow-up of a controlled trial. Blood. 1989;73:1729–34.

    Article  CAS  Google Scholar 

  19. Haber HP, Stern M. Intestinal ultrasonography in children and young adults: bowel wall thickness is age dependent. J Ultrasound Med. 2000;19:315–21.

    Article  CAS  Google Scholar 

  20. Koboziev I, Karlsson F, Grisham MB. Gut-associated lymphoid tissue, T cell trafficking, and chronic intestinal inflammation. Ann N Y Acad Sci. 2010;E86–E93.

  21. Kataoka Y, Iwasaki T, Kuroiwa T, Seto Y, Iwata N, Hashimoto N, et al. The role of donor T cells for target organ injuries in acute and chronic graft-versus-host disease. Immunology. 2001;103:310–8.

    Article  CAS  Google Scholar 

  22. Choi SW, Levine JE, Ferrara JLM. Pathogenesis and management of graft-versus-host disease. Immunol Allergy Clin North Am. 2010;30:75–101.

    Article  Google Scholar 

  23. Worlicek H, Lutz H, Heyder N, Matek W. Ultrasound findings in Crohn’s disease and ulcerative colitis: a prospective study. J Clin Ultrasound. 1987;15:153–63.

    Article  CAS  Google Scholar 

  24. Maconi G, Imbesi V, Bianchi PG. Doppler ultrasound measurement of intestinal blood flow in inflammatory bowel disease. Scand J Gastroenterol. 1996;31:590–3.

    Article  CAS  Google Scholar 

  25. Schölmerich J. Inflammatory bowel disease. Endoscopy. 1999;31:66–73.

    Article  Google Scholar 

  26. Bavil AS, Somi MH, Nemati M, Nadergoli BS, Ghabili K, Mirnour R, et al. Ultrasonographic evaluation of bowel wall thickness and intramural blood flow in ulcerative colitis. ISRN Gastroenterol. 2012;2012:370495.

    Article  Google Scholar 

  27. Haber HP, Schlegel PG, Dette S, Ruck P, Klingebiel T, Niethammer D. Intestinal acute graft-versus-host disease. Am J Roentgenol. 2000;174:118–20.

    Article  CAS  Google Scholar 

  28. Calabrese E, Zorzi F, Visconti E, De Angelis G, Cerretti R, Del Vecchio BG, et al. Bowel ultrasonography as an aid for diagnosis of intestinal acute graft-versus-host-disease after allogeneic haematopoietic stem cell transplantation. Dig Liver Dis. 2013;45:899–904.

    Article  Google Scholar 

  29. Klein SA, Martin H, Schreiber-Dietrich D, Hermann S, Caspary WF, Hoelzer D, et al. A new approach to evaluating intestinal acute graft-versus-host disease by transabdominal sonography and colour Doppler imaging. Br J Haematol. 2001;115:929–34.

    Article  CAS  Google Scholar 

  30. Benedetti E, Bruno B, McDonald GB, Paolicchi A, Caracciolo F, Papineschi F, et al. Prospective qualitative and quantitative non-invasive evaluation of intestinal acute GVHD by contrast-enhanced ultrasound sonography. Bone Marrow Transpl. 2013;48:1421–8.

    Article  CAS  Google Scholar 

  31. Gorg C, Wollenberg B, Beyer J, Stolte MS, Neubauer A. High-resolution ultrasonography in gastrointestinal graft-versus-host disease. Ann Hematol. 2005;84:33–9.

    Article  CAS  Google Scholar 

Download references

Acknowledgements

The authors thank the nurses and physicians who cared for the patients participating in this study.

Author information

Authors and Affiliations

  1. Immunotherapy and Post-BMT Complications Department, National Research Center for Hematology, Novyy Zykovskiy Proezd, d. 4, 125167, Moscow, Russian Federation

    Mikhail Drokov, Larisa Kuzmina, Vera Vasilyeva, Natalia Popova, Elena Parovichnikova & Valeriy Savchenko

  2. Bone Marrow Transplant Department, National Research Center for Hematology, Moscow, Russian Federation

    Mikhail Drokov, Larisa Kuzmina & Natalia Popova

  3. Immunochemotherapy Department for Patients After BMT, National Research Center for Hematology, Moscow, Russian Federation

    Darya Dubnyak, Vera Vasilyeva & Olga Starikova

  4. MRI and Ultrasonography Department, National Research Center for Hematology, Moscow, Russian Federation

    Galina Yatsyk, Anna Kireeva & Olga Pirikova

Authors
  1. Mikhail Drokov
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Galina Yatsyk
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Anna Kireeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Olga Pirikova
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Darya Dubnyak
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Larisa Kuzmina
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Vera Vasilyeva
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Natalia Popova
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Olga Starikova
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Elena Parovichnikova
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Valeriy Savchenko
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Mikhail Drokov.

Ethics declarations

Conflict of interest

There are no conflicts of interest to report.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Drokov, M., Yatsyk, G., Kireeva, A. et al. Bowel wall thickness is a strong predictor of steroid-refractory acute graft-versus-host disease with gut involvement after allo-HSCT. Int J Hematol 115, 545–552 (2022). https://doi.org/10.1007/s12185-021-03283-8

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12185-021-03283-8

Keywords

Search

Navigation