Journal Article

Endoscopic and Histological Findings Are Predicted by Fecal Calprotectin in Acute Intestinal Graft-Versus-Host-Disease

Hlinka, Michal, Ditschkowski, Markus, Steckel, Nina K., Koldehoff, Michael, Trenschel, Rudolf, Kordeals, Lambros, Adam, Birgit, Gromke, Tanja, Beelen, Dietrich W., Liebregts, Tobias

2016

Overview

Background Gastrointestinal graft-versus-host-disease (GI-GVHD) is a major cause of nonrelapse mortality after hematopoietic stem cell transplantation (HSCT) necessitating endoscopic examinations and biopsies for diagnosis. Fecal calprotectin (CPT) has been widely used in gastrointestinal inflammation, but comprehensive data in GI-GVHD are lacking. Aims We aimed to identify an association of CPT with endoscopic findings, mucosal damage and symptoms for diagnosing and monitoring acute GI-GVHD. Methods Symptoms were prospectively evaluated in 110 consecutive HSCT recipients by standardized questionnaires and Bristol Stool Scale (BSS). CPT was assayed by ELISA. Symptom assessment and CPT were performed weekly and with onset of first symptoms. GVHD was diagnosed according to the Glucksberg criteria and by endoscopic biopsies. Patients with GI-GVHD received standard high-dose corticosteroid therapy and follow-up CPT, and symptom evaluation was performed after 28 days. Patients not responding to steroid treatment were re-evaluated by colonoscopy. Results GI-GVHD was diagnosed in 40 patients. Twelve patients with GI symptoms and CMV colitis and 24 patients with isolated skin GVHD were included as control subjects. CPT was significantly higher in GI-GVHD compared to skin GVHD and CMV colitis. Endoscopic findings, histological grading, abdominal cramps, diarrhea, urgency and BSS correlated with CPT. At follow-up, CPT correlated with abdominal cramps, diarrhea, urgency and BSS. In steroid refractory patients, CPT level was still significantly associated with severity of mucosal damage. Conclusion CPT predicts endoscopic and histological findings in GI-GVHD and correlates with lower GI symptoms. It enables to discriminate GVHD from CMV colitis and to monitor therapeutic success.

• Publisher: Springer US,Springer,Springer Nature B.V
• Subject: Adult / Aged / Biochemistry / Biomarkers / Colitis / Corticosteroids / Cytomegalovirus infections / Diarrhea / Enzyme-linked immunosorbent assay / Feces - chemistry / Female / Gastroenterology / Gastrointestinal Diseases - etiology / Graft vs Host Disease - diagnosis / Graft vs Host Disease - metabolism / Health aspects / Hematopoietic Stem Cell Transplantation - adverse effects / Hematopoietic stem cells / Hepatology / Humans / Leukocyte L1 Antigen Complex - chemistry / Male / Medicine / Medicine & Public Health / Middle Aged / Mortality / Oncology / Original Article / Stem cells / Transplant Surgery / Transplantation / Young Adult