Diagnosis and grading of acute graft-versus-host disease in endoscopic biopsy series throughout the upper and lower intestine in patients after allogenic hematopoietic stem cell transplantation: a systematic approach

Abstract

Intestinal graft-versus-host disease (GvHD) is a potentially life-threatening condition after allogenic hematological stem cell transplantation (alloHSCT). Although efforts have been made to determine the best sites for endoscopic biopsies, an approach involving all accessible anatomical regions is lacking. We investigated 22 complete biopsy series, each comprising biopsies from 10 different sites of the upper and lower intestine from 21 patients. The majority of biopsies investigated revealed histological signs of acute GvHD. The highest incidence and most advanced grades of acute GvHD were found in the right colon and terminal ileum. We detected significant correlations between crypt or gland loss and histological grades of acute GvHD, and between the number of sites with crypt or gland loss and the time elapsed since alloHSCT. Our results indicate that the most informative biopsies for GvHD diagnosis were those from the right colon and terminal ileum, and from the duodenum for the upper intestine.