scholarly journals Intestinal Pneumatosis and Perforation Are a Rare but Serious Manifestation of Gastrointestinal Graft-Vs.-Host Disease Following Allogeneic Stem Cell Transplant

2021 ◽  
Vol 27 (3) ◽  
pp. S290-S291
Author(s):  
Kimberly J. Langer ◽  
Mark R. Litzow ◽  
William J. Hogan ◽  
Mithun V. Shah ◽  
Hassan B. Alkhateeb ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Host Disease ◽  
Intestinal Pneumatosis ◽  
Graft Vs Host Disease

scholarly journals Pneumatosis Is a Rare but Serious Manifestation of Gastrointestinal Graft-Vs.-Host Disease Following Allogeneic Stem Cell Transplant

2021 ◽  
Vol 27 (3) ◽  
pp. S273-S274
Author(s):  
Kimberly J. Langer ◽  
Mithun V. Shah ◽  
Mark R. Litzow ◽  
Hassan B. Alkhateeb ◽  
William J. Hogan ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Host Disease ◽  
Graft Vs Host Disease

scholarly journals Pityriasis rubra pilaris‐like graft‐vs‐host disease following allogeneic stem cell transplant in two patients

2019 ◽  
Vol 7 (12) ◽  
pp. 2491-2494
Author(s):  
Jennifer Y. Wang ◽  
Mika M. Tabata ◽  
Silvina Pugliese ◽  
Darci Phillips ◽  
Jinah Kim ◽  
...  
Keyword(s):  
Stem Cell ◽  
Stem Cell Transplant ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Host Disease ◽  
Pityriasis Rubra Pilaris ◽  
Graft Vs Host Disease

scholarly journals 225. Bloodstream Infections in Adult Allogeneic Stem Cell Transplant Recipients with Acute Gastrointestinal Graft-vs. -Host Disease within the First 180 Days Post-Transplantation

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S130-S131
Author(s):  
Anita R Modi ◽  
Lisa A Rybicki ◽  
Navneet Majhail ◽  
Sherif B Mossad
Keyword(s):  
Stem Cell ◽  
Mortality Risk ◽  
Stem Cell Transplant ◽  
Bloodstream Infections ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Post Transplantation ◽  
Host Disease ◽  
Graft Vs Host Disease ◽  
Overall Mortality

Abstract Background Infections are the most common cause of non-relapse mortality in adult allogeneic stem cell transplant (allo SCT) recipients. Acute gastrointestinal graft-vs.-host disease (GI GVHD) often leads to friable mucosa and interventions increasing infectious risk. We describe the relationships between increasing grades of acute GI GVHD and incidence of bloodstream infections (BSI) at our institution. Methods We reviewed 441 adults who underwent allo SCT from 2011 to 2017 and were diagnosed with GI GVHD, non-GI GVHD, or no GVHD based on the Modified Glucksberg Scale within the first 100 days of transplant. The maximum grades of GI GVHD and non-GI GVHD were used in the analysis. A BSI episode constituted a blood culture positive for bacteria or fungi and antibiotic treatment. The incidence of BSI within the first 180 days of transplantation was estimated with the cumulative incidence method. Results Overall BSI incidence by day 180 was 32%; Gram-negative bacilli were the predominant organisms. Adjusting for grade of non-GI GVHD, patients with acute grade 4 GI GVHD had higher risk of BSI as compared with patients with no GI GVHD (HR 3.02, P < 0.001), while those with grade 3 GI GVHD had similar risk (HR 1.01, P = 0.98). Patients with grade 1 or 2 GI GVHD demonstrated lower BSI risk compared with those with no GI GVHD (HR 0.48, P = 0.015; HR 0.44, P = 0.08, respectively). Results were similar after adjusting for patient- and transplant-related risk factors for BSI. Grade of GI GVHD had no association with non-BSI risk. Patients who developed BSI or non-BSI had significantly higher overall mortality risk compared with those without infectious complications (HR 2.52, P < 0.001 for BSI; HR 1.60, P = 0.001 for non-BSI). Conclusion Acute grade 4 GI GVHD may reliably indicate higher BSI and overall mortality risk in this population. Understanding the relationships between acute GI GVHD and BSI can guide future treatment strategies for adult allo SCT recipients. Disclosures All authors: No reported disclosures.

Successful Full-Term Live Birth in an Allogeneic Stem Cell Transplant Patient with Active Extensive Chronic Graft-Versus-Host Disease.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 5016-5016
Author(s):  
Heather Shah ◽  
Donna Salzman ◽  
Khaleel Ashraf ◽  
William Vaughan
Keyword(s):  
Stem Cell ◽  
Graft Versus Host Disease ◽  
Stem Cell Transplant ◽  
Solid Organ ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Fk 506 ◽  
Host Disease ◽  
Graft Versus Host ◽  
Patient Reported

Abstract Objective: Little information exists regarding pregnancy after allogeneic stem cell transplantation. Pregnancy in the setting of active graft-versus-host disease (GVHD) is even less common. We report an interesting case of a patient with active GVHD who had a spontaneous pregnancy four years after allogeneic stem cell transplant and whose GVHD remained stable during her pregnancy. Patient information: Our patient is a 27 year-old African-American female who was diagnosed with aplastic anemia in January 2002. She was initially treated with anti-thymocyte gamma globulin (ATG) and cyclosporine with minimal response. She was red blood cell and platelet transfusion dependent during this time. She was referred to the UAB Bone Marrow Transplant Center for evaluation for allogeneic stem cell transplant in June 2002. Her conditioning regimen included cyclophosphamide and ATG. She received her stem cell transplant on July 30, 2002 and was no longer transfusion dependent seven months after her transplant. In January 2003, the patient was diagnosed with GVHD of her oropharynx and skin. She was treated with cyclosporine and oral solumedrol initially. By February 2003, mycophenolate mofetil was added to her regimen. She was tapered off of the solumedrol by day +366 and maintained on cyclosporine and mycophenolate. Tapering of her immunosuppressive medication was attempted multiple times unsuccessfully. Unfortunately, she progressed to sclerodermatous changes of the skin that were confirmed as GVHD by biopsy. She started psoralen and UVA light therapy (PUVA) in August 2004. Subsequently, she was treated with topical hydroquinone and FK-506 along with photopheresis and physical and occupational therapy. Pentoxifylline and vitamin E were added in August 2005. By August 2006, photopheresis had been decreased to every month and she was controlled on mycophenolate and photopheresis. Planned immunosuppressant taper at four years post-transplant was complicated by an unplanned pregnancy at that time. The patient’s photopheresis was discontinued because of concerns for teratogenicity with psoralens. During her pregnancy, the patient was maintained on full dose mycophenolate and low dose oral FK-506. Of note, the patient was not on any estrogen supplementation at the time of conception. The patient was monitored by the transplant team serially throughout her pregnancy. Her GVHD did not progress objectively, and the patient reported subjective improvement. The patient went on to deliver a healthy female infant at term via C-section. Conclusions: Ours is the first reported case of pregnancy and successful delivery of a healthy infant in a patient with active extensive chronic GVHD. On review of the literature, only a few cases of spontaneous pregnancies after allogeneic stem cell transplant have been reported, and they typically involve reduced dose intensity chemoradiotherapy or occur in premenarchal patients. There are twenty unconfirmed cases of pregnancy in the transplant registry. More cases have been reported in solid organ transplant patients on immunosuppressive medications. As transplants for non-malignant disorders and the use of nonmyeloablative transplants increase, we expect to see more cases of pregnancy after transplant. Attention to fertility issues and monitoring for pregnancy in potentially fertile patients needs to be considered. Also, further research into the altered immune state during pregnancy may lead to further understanding of the mechanism of GVHD and possibly novel treatments.

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