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Dezan MGF, Cavalcante LN, Silva HRC, de Moura Almeida A, de Assis LHDS, de Freitas TT, de Araújo MAS, Cotrim HP, Lyra AC. Editorial: How often can we get the right diagnosis after bone marrow transplant in patients with abnormal liver function tests? Authors' reply. Aliment Pharmacol Ther 2024; 59:707-708. [PMID: 38349704 DOI: 10.1111/apt.17870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
LINKED CONTENTThis article is linked to Dezan et al papers. To view these articles, visit https://doi.org/10.1111/apt.17756 and https://doi.org/10.1111/apt.17840
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Affiliation(s)
- Maria Gabriela Fernandes Dezan
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lourianne Nascimento Cavalcante
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Hugo Rodrigues Carvalho Silva
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
| | - Alessandro de Moura Almeida
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Hematology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Tiago Thalles de Freitas
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
| | - Marco Aurélio Salvino de Araújo
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Hematology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Helma Pinchemel Cotrim
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Andre Castro Lyra
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
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Dezan MGF, Cavalcante LN, Silva HRC, de Moura Almeida A, Dos Santos de Assis LH, de Freitas TT, de Araújo MAS, Cotrim HP, Lyra AC. Hepatobiliary disease after bone marrow transplant: A cross-sectional study of 377 patients. Aliment Pharmacol Ther 2024; 59:71-79. [PMID: 37833826 DOI: 10.1111/apt.17756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/03/2023] [Accepted: 09/28/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Bone marrow transplantation (BMT) is a standard treatment for several haematologic conditions. Following BMT, patients may develop hepatobiliary complications that impact morbidity and mortality. The differential diagnosis may include drug-induced liver injury (DILI), sepsis-associated liver injury (SALI), sinusoidal obstruction syndrome (SOS), graft-versus-host disease (GVHD), viral hepatitis, ischaemic hepatitis, and fulminant hepatitis. AIMS To evaluate the frequency, clinical characteristics, and outcomes of patients with hepatobiliary alterations associated with BMT in a tertiary referral centre. METHODS This was a cross-sectional study with data collected from the medical records of patients undergoing BMT between January 2017 and June 2022. We diagnosed hepatobiliary complications based on established criteria. RESULTS We included 377 patients; 55.7% had hepatobiliary complications. Female gender, pre-BMT hepatobiliary alteration, and haploidentical allogeneic transplantation were associated with increased risk with odds ratios (OR) of 1.8 (p = 0.005), 1.72 (p = 0.013) and 3.25 (p = 0.003), respectively. Patients with hepatobiliary complications spent longer in the hospital than those without (27.7 × 19.3 days, respectively; p < 0.001). Among 210 patients with hepatobiliary complications, 28 died compared to 5 of 167 without complications (OR 4.98; p = 0.001). CONCLUSIONS Hepatobiliary complications are frequent in patients undergoing BMT. There is a greater risk of their occurrence in women, people with pre-BMT liver alterations, and in haploidentical transplants. The occurrence of these complications increases the length of stay and is associated with a higher risk of death.
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Affiliation(s)
- Maria Gabriela Fernandes Dezan
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lourianne Nascimento Cavalcante
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Hugo Rodrigues Carvalho Silva
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
| | - Alessandro de Moura Almeida
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Hematology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
| | | | - Tiago Thalles de Freitas
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
| | - Marco Aurélio Salvino de Araújo
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Hematology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Hematology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
| | - Helma Pinchemel Cotrim
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
| | - Andre Castro Lyra
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael-Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil
- Gastro-Hepatology Service-University Hospital Professor Edgard Santos (HUPES), Federal University of Bahia, Salvador, Bahia, Brazil
- Postgraduate Program in Medicine and Health, Federal University of Bahia, Salvador, Bahia, Brazil
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Dezan MGF, Cavalcante LN, Cotrim HP, Lyra AC. Hepatobiliary disease after bone marrow transplant. Expert Rev Gastroenterol Hepatol 2023; 17:129-143. [PMID: 36655915 DOI: 10.1080/17474124.2023.2169671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Bone marrow transplantation (BMT) is the standard treatment for several hematologic pathologies. Post-BMT patients may develop hepatobiliary complications that impact morbidity and mortality. The differential diagnosis may include drug-induced liver injury (DILI), sepsis-associated liver injury (SALI), sinusoidal obstruction syndrome (SOS), graft-versus-host disease (GVHD), viral hepatitis, ischemic and fulminant hepatitis, among others. AREA COVERED Defining the etiology of hepatobiliary injury is challenging due to the overlapping symptoms. Thus, it is necessary to be aware of and understand the clinical characteristics of these hepatobiliary complications and provide adequate management with possible better outcomes. We reviewed the scientific literature focused on early hepatobiliary complications associated with BMT. We searched the PubMed database using the following descriptors: hepatic complications, drug-induced liver disease, graft-versus-host disease, cholestasis, sepsis, sinusoidal obstruction syndrome, cytomegalovirus, viral hepatitis, bone marrow transplantation, and hematopoietic stem cell transplantation. EXPERT OPINION Post-BMT hepatobiliary complications comprise several differential diagnoses and are challenges for the hepatologist's clinical practice. When evaluating these patients, it is necessary to consider the temporality between the use of certain medications, the increase in liver enzymes, and the presence of infection, in addition to applying diagnostic criteria and complementary tests for a specific diagnosis.
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Affiliation(s)
- Maria Gabriela Fernandes Dezan
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Lourianne Nascimento Cavalcante
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Helma Pinchemel Cotrim
- Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
| | - Andre Castro Lyra
- Instituto D'Or de Pesquisa e Ensino (IDOR) and Hospital São Rafael Gastro-Hepatology Service, Hospital São Rafael, Salvador, Bahia, Brazil.,Gastro-Hepatology Service - University Hospital Professor Edgard Santos (HUPES), PPGMS - Federal University of Bahia, Salvador, Bahia, Brazil
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Kurya AU, Aliyu U, Tudu AI, Usman A, Yusuf M, Gupta S, Ali A, Gulfishan M, Singh SK, Hussain I, Abubakar MG. Graft-versus-host disease: Therapeutic prospects of improving the long-term post-transplant outcomes. TRANSPLANTATION REPORTS 2022. [DOI: 10.1016/j.tpr.2022.100107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
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Yang AH, Han MAT, Samala N, Rizvi BS, Marchalik R, Etzion O, Wright EC, Patel R, Khan V, Kapuria D, Samala Venkat V, Kleiner DE, Koh C, Kanakry JA, Kanakry CG, Pavletic S, Williams KM, Heller T. Abnormal liver tests are not sufficient for diagnosis of hepatic graft-versus-host disease in critically ill patients. Hepatol Commun 2022; 6:2210-2220. [PMID: 35527712 PMCID: PMC9315132 DOI: 10.1002/hep4.1965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 02/25/2022] [Accepted: 03/22/2022] [Indexed: 11/11/2022] Open
Abstract
Hepatic graft-versus-host disease (HGVHD) contributes significantly to morbidity and mortality after hematopoietic stem cell transplantation (HSCT). Clinical findings and liver biomarkers are neither sensitive nor specific. The relationship between clinical and histologic diagnoses of HGVHD was assessed premortem and at autopsy. Medical records from patients who underwent HSCT at the National Institutes of Health (NIH) Clinical Center between 2000 and 2012 and expired with autopsy were reviewed, and laboratory tests within 45 days of death were divided into 15-day periods. Clinical diagnosis of HGVHD was based on Keystone Criteria or NIH Consensus Criteria, histologic diagnosis based on bile duct injury without significant inflammation, and exclusion of other potential etiologies. We included 37 patients, 17 of whom had a cholestatic pattern of liver injury and two had a mixed pattern. Fifteen were clinically diagnosed with HGVHD, two showed HGVHD on autopsy, and 13 had histologic evidence of other processes but no HGVHD. Biopsy or clinical diagnosis of GVHD of other organs during life did not correlate with HGVHD on autopsy. The diagnostic accuracy of the current criteria was poor (κ = -0.20). A logistic regression model accounting for dynamic changes included peak bilirubin 15 days before death, and an increase from period -30 (days 30 to 16 before death) to period -15 (15 days before death) showed an area under the receiver operating characteristic curve of 0.77. Infection was the immediate cause of death in 68% of patients. In conclusion, liver biomarkers at baseline and GVHD elsewhere are poor predictors of HGVHD on autopsy, and current clinical diagnostic criteria have unsatisfactory performance. Peak bilirubin and cholestatic injury predicted HGVHD on autopsy. A predictive model was developed accounting for changes over time. Further validation is needed.
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Affiliation(s)
- Alexander H Yang
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Mai Ai Thanda Han
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Niharika Samala
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Bisharah S Rizvi
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Rachel Marchalik
- Experimental Transplantation and Immunotherapy BranchNational Cancer Institute (NCI)BethesdaMarylandUSA
| | - Ohad Etzion
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Elizabeth C Wright
- Office of the DirectorNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Ruchi Patel
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Vinshi Khan
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Devika Kapuria
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Vikramaditya Samala Venkat
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - David E Kleiner
- Laboratory of PathologyNational Cancer Institute (NCI)BethesdaMarylandUSA
| | - Christopher Koh
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
| | - Jennifer A Kanakry
- Experimental Transplantation and Immunotherapy BranchNational Cancer Institute (NCI)BethesdaMarylandUSA
| | - Christopher G Kanakry
- Experimental Transplantation and Immunotherapy BranchNational Cancer Institute (NCI)BethesdaMarylandUSA
| | - Steven Pavletic
- Immune Deficiency Cellular Therapy ProgramNational Cancer Institute (NCI)BethesdaMarylandUSA
| | - Kirsten M Williams
- Department of PediatricsAflac Cancer and Blood Disorders CenterChildren's Healthcare of Atlanta, Emory UniversityAtlantaGeorgiaUSA
| | - Theo Heller
- Liver Diseases BranchNational Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)BethesdaMarylandUSA
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Yu C, Sun Y, Xu L, Zhang X, Liu K, Jin J, Huang X, Wang Y. Hepatitis B Seropositive Status in Recipients or Donors Is Not Related to Worse Outcomes after Haploidentical Hematopoietic Stem Cell Transplantation. Transplant Cell Ther 2021; 27:668.e1-668.e9. [PMID: 34052506 DOI: 10.1016/j.jtct.2021.05.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 05/15/2021] [Accepted: 05/19/2021] [Indexed: 12/19/2022]
Abstract
Hepatitis B virus (HBV) has a high rate of chronic infection in Asian populations, and only limited studies have been performed to analyze the impact of HBV-seropositive haploidentical hematopoietic stem cell transplantation (haplo-HSCT) recipients and donors. The present study aimed to evaluate the effect on clinical outcomes in those patients. We conducted a retrospective study enrolling 237 consecutive patients undergoing first haplo-HSCT. The patients were classified into 3 groups: recipient HBV-positive group (R+D-; n = 62), donor HBV-positive group (D+; n = 83), and HBV-negative group (R-D-; n = 92). Corresponding prophylactic antiviral treatment was given in the R+D- and D+ groups. The results were compared among the 3 groups using the Kruskal-Wallis test for continuous variables, Pearson's chi-square test for categorical variables, the competing-risk method to evaluate cumulative incidence, Kaplan-Meier curves to estimate overall survival (OS) and disease-free survival (DFS), and a Cox proportional hazard model to analyze multivariable influences. The 3-year cumulative HBV reactivation rate was 4.2%. The median time to HBV reactivation was 845 days (range, 545 to 1439 days) after haplo-HSCT. The R+D- group tended to have a higher cumulative incidence of HBV reactivation compared with the D+ group (11.8% versus 3.1%; P = .080). Significant differences in the causes of hepatic damage were observed among the 3 groups (P = .017), and all patients with acute hepatitis B after haplo-HSCT were from the R+D- group. Multivariate analysis showed that pretransplantation HBV status was associated with cytomegalovirus reactivation (R+D- versus R-D-: hazard ratio, 1.514; 95% confidence interval, 1.060 to 2.163; P = .023). The 3-year OS and DFS, 3-year cumulative incidence of nonrelapse mortality (NRM), rates of relapse and graft-versus-host disease (GVHD), and causes of death were comparable among the 3 groups. Pretransplantation HBV serostatus had no significant effect on OS, DFS, NRM, relapse, or GVHD in the multivariate analysis. Based on our data, seropositivity for hepatitis B surface antigen (HbsAg) or core antibody (HBcAb) in donors or recipients before transplantation did not negatively affect the overall outcome after haplo-HSCT under the premise of proper antiviral prophylaxis along with regular post-transplantation surveillance, and HBV seropositivity should not be considered a contraindication to haplo-HSCT.
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Affiliation(s)
- Chunzi Yu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Yuqian Sun
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Lanping Xu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiaohui Zhang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Kaiyan Liu
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Jian Jin
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China
| | - Xiaojun Huang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China
| | - Yu Wang
- Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Research Unit of Key Technique for Diagnosis and Treatments of Hematologic Malignancies, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China; Collaborative Innovation Center of Hematology, Peking University, Beijing, China.
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Fuji S, Maeshima AM, Kim SW, Fukuda T. Significant nutrient deposition in the liver after allogeneic hematopoietic stem cell transplantation: pathological analysis of 25 autopsy cases. Bone Marrow Transplant 2017; 52:781-782. [PMID: 28112747 DOI: 10.1038/bmt.2016.367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- S Fuji
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - A M Maeshima
- Department of Pathology and Clinical Laboratory, National Cancer Center Hospital, Tokyo, Japan
| | - S-W Kim
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
| | - T Fukuda
- Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan
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Matsukuma KE, Wei D, Sun K, Ramsamooj R, Chen M. Diagnosis and differential diagnosis of hepatic graft versus host disease (GVHD). J Gastrointest Oncol 2016; 7:S21-31. [PMID: 27034810 DOI: 10.3978/j.issn.2078-6891.2015.036] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Graft versus host disease (GVHD) is a common complication following allogeneic hematopoietic cell transplantation (HCT) that typically manifests as injury to the skin, gastrointestinal mucosa, and liver. In some cases, hepatic GVHD may be histologically indistinguishable from other disorders such as infection and drug-induced liver injury (DILI). Additionally, clinical signs and symptoms are frequently confounded by the superimposed effects of pretransplant chemoradiotherapy, immunotherapy (IT) (targeted to the underlying malignancy), GVHD prophylaxis, and infection. Thus, careful attention to and correlation with clinical findings, laboratory values, and histologic features is essential for diagnosis. This review, aimed at the practicing pathologist, will discuss current clinical and histologic criteria for GVHD, the approach to diagnosis of hepatic GVHD, and features helpful for distinguishing it from other entities in the differential diagnosis.
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Affiliation(s)
- Karen E Matsukuma
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| | - Dongguang Wei
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| | - Kai Sun
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| | - Rajendra Ramsamooj
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
| | - Mingyi Chen
- 1 Department of Pathology and Laboratory Medicine, University of California, Davis Medical Center, Sacramento, CA 95817, USA ; 2 Department of Hematology, Zhengzhou University People's Hospital, Zhengzhou 450000, China
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Kim MJ, Han SW, Lee DW, Cha Y, Lee KH, Kim TY, Oh DY, Kim SH, Im SA, Bang YJ, Kim TY. Splenomegaly and Its Associations with Genetic Polymorphisms and Treatment Outcome in Colorectal Cancer Patients Treated with Adjuvant FOLFOX. Cancer Res Treat 2016; 48:990-7. [PMID: 26790967 PMCID: PMC4946369 DOI: 10.4143/crt.2015.296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 12/19/2015] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Splenomegaly is a clinical surrogate of oxaliplatin-induced sinusoidal obstruction syndrome (SOS). We investigated development of splenomegaly and its association with treatment outcome and genetic polymorphisms following adjuvant 5-fluorouracil, leucovorin, and oxaliplatin (FOLFOX) in colorectal cancer (CRC) patients. MATERIALS AND METHODS Splenomegaly was determined by spleen volumetry using computed tomography images obtained before initiation of chemotherapy and after completion of adjuvant FOLFOX in CRC patients. Ten genetic polymorphisms in 4 SOS-related genes (VEGFA, MMP9, NOS3, and GSTP1) were analyzed using DNA from peripheral blood mononuclear cells. RESULTS Of 124 patients included, increase in spleen size was observed in 109 (87.9%). Median change was 31% (range, -42% to 168%). Patients with splenomegaly had more severe thrombocytopenia compared to patients without splenomegaly during the chemotherapy period (p < 0.0001). The cumulative dose of oxaliplatin and the lowest platelet count during the chemotherapy period were clinical factors associated with splenomegaly. However, no significant associations were found between genetic polymorphisms and development of splenomegaly. Disease-free survival was similar regardless of the development of splenomegaly. CONCLUSION Splenomegaly was frequently observed in patients receiving adjuvant FOLFOX and resulted in more severe thrombocytopenia but did not influence treatment outcome. Examined genetic polymorphisms did not predict development of splenomegaly.
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Affiliation(s)
- Mi-Jung Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea.,Center for Gastric Cancer, National Cancer Center, Goyang, Korea
| | - Sae-Won Han
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Won Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Yongjun Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Kyung-Hun Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-Yong Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Do-Youn Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Se Hyung Kim
- Department of Radiology and Institute of Radiation Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Yung-Jue Bang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Tae-You Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
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Young JAH, Weisdorf DJ. Infections in Recipients of Hematopoietic Stem Cell Transplants. MANDELL, DOUGLAS, AND BENNETT'S PRINCIPLES AND PRACTICE OF INFECTIOUS DISEASES 2015. [PMCID: PMC7152282 DOI: 10.1016/b978-1-4557-4801-3.00312-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Norvell JP. Liver disease after hematopoietic cell transplantation in adults. Transplant Rev (Orlando) 2014; 29:8-15. [PMID: 25315987 DOI: 10.1016/j.trre.2014.08.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2014] [Revised: 08/10/2014] [Accepted: 08/22/2014] [Indexed: 01/22/2023]
Abstract
Liver-related complications constitute a large component of the overall morbidity and mortality associated with hematopoietic cell transplantation. Affecting up to 80% of allogeneic HCT recipients, prompt recognition and treatment are essential. The differential diagnosis is broad and is best categorized by time of onset after transplantation. Early complications include drug-induced liver injury, sinusoidal obstruction syndrome, and graft-versus-host disease. Late complications include infectious sequelae, cirrhosis, and hepatic malignancies. Patients being considered for hematopoietic cell transplantation should be screened and evaluated for liver-related complications to help improve outcomes.
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Affiliation(s)
- J P Norvell
- Department of Medicine, Division of Digestive Diseases, Emory Transplant Center, Emory University, Atlanta, GA, USA.
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12
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Tachibana T, Nozaki A, Enaka M, Yamamoto E, Kawasaki R, Koharazawa H, Hagihara M, Ishibashi D, Nakajima Y, Kuwabara H, Tomita N, Ishigatsubo Y, Fujisawa S. Drug-induced liver injury after allogeneic bone marrow transplantation. Int J Hematol 2013; 98:499-503. [PMID: 24037455 DOI: 10.1007/s12185-013-1434-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 09/05/2013] [Accepted: 09/05/2013] [Indexed: 11/29/2022]
Abstract
A 23-year-old woman developed acute severe hepatitis and jaundice on day 183 after bone marrow transplantation from HLA-B antigen mismatched-related donor. The administration of prednisolone and cessation of the prescribed drugs resolved the liver injury. Drug lymphocyte stimulation test was positive for acyclovir, and liver biopsy indicated the characteristics of drug-induced liver injury (DILI) rather than graft-versus-host disease. Physicians should keep DILI in mind when considering differential diagnosis for liver complications after allogeneic cell transplantation.
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Affiliation(s)
- Takayoshi Tachibana
- Department of Hematology, Yokohama City University Medical Center, Yokohama, Japan,
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13
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Bano G, Chong H, Vlahos I. A new long term hepatic complication in survivors of childhood haematological malignancy. Med Hypotheses 2012; 79:663-6. [PMID: 22951417 DOI: 10.1016/j.mehy.2012.08.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 07/21/2012] [Accepted: 08/03/2012] [Indexed: 12/26/2022]
Abstract
Hepatic abnormalities have been documented in survivors of childhood malignancies and a spectrum of liver diseases has been described in this group The risk factors for liver disease include: hepatic surgery; radiotherapy to field including liver; total body irradiation (TBI); chemotherapy, multiple blood transfusions and use of hematopoietic cell transplantation. We report three cases of hepatic adenomatosis (HA) in young women who had been treated for haematological malignancy as children and had bone marrow transplant. These women were on estrogen and growth hormone replacement. They had mild abnormalities of liver function tests. The diagnosis of HA was made on liver imaging and confirmed by liver biopsy. We also propose a hypothesis for the pathogenesis of hepatic adenomatosis in these patients which vascular damage, estrogen replacement and growth hormone deficiency.
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Affiliation(s)
- G Bano
- Cellular and Molecular Medicine, St. George's University of London, London SW17 0RE, United Kingdom.
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14
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Barney BM, Olivier KR, Miller RC, Haddock MG. Clinical outcomes and toxicity using stereotactic body radiotherapy (SBRT) for advanced cholangiocarcinoma. Radiat Oncol 2012; 7:67. [PMID: 22553982 PMCID: PMC3464963 DOI: 10.1186/1748-717x-7-67] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Accepted: 04/26/2012] [Indexed: 12/11/2022] Open
Abstract
Background To report single-institutional clinical outcomes and toxicity with SBRT for cholangiocarcinoma. Methods From March 2009 to July 2011, 10 patients with 12 unresectable primary (n = 6) or recurrent (n = 6) cholangiocarcinoma lesions underwent abdominal SBRT. Sites treated included liver (n = 10), abdominal lymph nodes (n = 1), and adrenal gland (n = 1). SBRT was delivered in three (n = 2) or five (n = 10) consecutive daily fractions over one week. The median prescription dose was 55 Gy (range, 45–60). Treatment response was graded by RECIST v.1.1, and toxicities were scored by CTCAE v.4.0. Data was analyzed using the Kaplan-Meier method to determine rates of local control (LC), freedom from distant progression (FFDM) and overall survival (OS). Results The median follow-up was 14 months (range, 2–26 months). LC, defined as freedom from progression within the SBRT field, was 100%, but four patients treated to intrahepatic sites experienced progression elsewhere in the liver. Estimates for FFDM at 6 and 12 months were 73% and 31%, respectively. Sites of disease relapse included liver (n = 3), liver and lymph nodes (n = 1), liver and lungs (n = 1), lymph nodes (n = 1), and mesentery (n = 1). OS estimates for the cohort at 6 and 12 months were 83% and 73%, respectively. The most common Grade ≥2 early toxicities were Grade 2 nausea and vomiting (n = 5) and gastrointestinal pain (n = 2). Late ≥2 toxicities included Grade 2 gastrointestinal pain (n = 3), Grade 3 biliary stenosis (n = 1), and Grade 5 liver failure (n = 1). Conclusions SBRT shows promise as an effective local therapy for properly-selected patients with cholangiocarcinoma. Further follow-up is needed to better quantify the risk of late complications associated with SBRT.
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Affiliation(s)
- Brandon M Barney
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA.
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15
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Koenecke C, Pischke S, Heim A, Raggub L, Bremer B, Raupach R, Buchholz S, Schulz T, Manns M, Ganser A, Wedemeyer H. Chronic hepatitis E in hematopoietic stem cell transplant patients in a low-endemic country? Transpl Infect Dis 2011; 14:103-6. [DOI: 10.1111/j.1399-3062.2011.00702.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2011] [Revised: 10/28/2011] [Accepted: 11/06/2011] [Indexed: 11/26/2022]
Affiliation(s)
- C. Koenecke
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation; Hannover Medical School; Hannover; Germany
| | - S. Pischke
- Department of Gastroenterology, Hepatology, and Endocrinology; Hannover Medical School; Hannover; Germany
| | - A. Heim
- Institute of Virology; Hannover Medical School; Hannover; Germany
| | - L. Raggub
- Institute of Virology; Hannover Medical School; Hannover; Germany
| | - B. Bremer
- Department of Gastroenterology, Hepatology, and Endocrinology; Hannover Medical School; Hannover; Germany
| | - R. Raupach
- Department of Gastroenterology, Hepatology, and Endocrinology; Hannover Medical School; Hannover; Germany
| | - S. Buchholz
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation; Hannover Medical School; Hannover; Germany
| | - T. Schulz
- Institute of Virology; Hannover Medical School; Hannover; Germany
| | - M.P. Manns
- Department of Gastroenterology, Hepatology, and Endocrinology; Hannover Medical School; Hannover; Germany
| | - A. Ganser
- Department of Hematology, Hemostasis, Oncology, and Stem Cell Transplantation; Hannover Medical School; Hannover; Germany
| | - H. Wedemeyer
- Department of Gastroenterology, Hepatology, and Endocrinology; Hannover Medical School; Hannover; Germany
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Abstract
Sinusoidal obstruction syndrome (SOS), formerly named venoocclusive disease, is a well-known complication of hematopoietic stem cell transplantation and ingestion of food or drinks contaminated by pyrrolizidine alkaloids. Many other drugs and toxins have been associated with SOS, including several chemotherapeutic agents and immunosuppressors. SOS contributes to significant morbidity and mortality in all these settings. This review describes the histologic lesions of SOS, details its pathogenesis as it is understood today, specifies the recent data on its causes and how it may influence clinical management of colorectal liver metastases, and discusses the current knowledge on diagnosis and preventive options.
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