New insight for the diagnosis of gastrointestinal acute graft-versus-host disease

Abstract

Allogeneic stem cell transplantation (allo-SCT) is a curative therapy for different life-threatening malignant and nonmalignant hematologic disorders. Graft-versus-host disease (GVHD) remains a major source of morbidity and mortality following allo-SCT, which limits the use of this treatment in a broader spectrum of patients. Early diagnostic of GVHD is essential to initiate treatment as soon as possible. Unfortunately, the diagnosis of GVHD may be difficult to establish, because of the nonspecific nature of the associated symptoms and of the numerous differential diagnosis. This is particularly true regarding gastrointestinal (GI) acute GVHD. In the recent years many progress has been made in medical imaging test and endoscopic techniques. The interest of these different techniques in the diagnosis of GI acute GVHD has been evaluated in several studies. With this background we review the contributions, limitations, and future prospect of these techniques in the diagnosis of GI acute GVHD.

Figure 1

Example of a true positive patient: ¹⁸F-FDG PET/CT performed 25 days after allo-SCT in a 46-year-old patient who presented with signs of acute GI-GvHD 30 days after allo-SCT.

Figure 2

Small bowel lesions of GI-GVHD detected by wireless capsule endoscopy (WCE). (a) Normal jejunum, (b) focal edema and enanthematous aspect of the jejunum, (c) aphtoid erosion in the proximal ileum, and (d) large superficial ulceration of the ileum.

Figure 3

Probe-based confocal laser endomicroscopy (pCLE) patterns observed in GI-GVHD patients following intravenous injection of fluorescein. (a) Normal sigmoid, (b) abnormal microvessel network with dilation of a microvessel surrounding a colonic crypt (mild GVHD), (c) mild increase in fluorescein intensity in the lamina propria (mild GVHD), (d) distorted crypts (moderate GVHD), and ((e), (f)) major architectural changes showing proliferation and dilation of microvessels in the lamina propria, major fluorescein extravasation, and complete destruction of the colonic crypt architecture (severe GVHD).