GASTROINTESTINAL EMERGENCIES IN PATIENTS WITH ACUTE INTESTINAL GRAFT-VERSUS-HOST DISEASE

Acute intestinal graft-versus-host disease (GVHD) develops in about 30 -50% of allogeneic bone-marrow transplant recipients: 10-20% have gast rointestinal emergencies (hemorrhage or perforation). Mortality reache s 30-60% in patients with acute, grade 2-4 GVHD. We studied 36 bone ma rrow recipients in whom acute intestinal GVHD developed. Seven had gas trointestinal emergencies: 4 severe gastrointestinal bleeding and 3 ac ute peritonitis. Three patients with gastrointestinal bleeding and one patient with peritonitis responded to medical therapy. Three needed s urgery: one with bleeding and two with peritonitis, while 1 patient ha d embolization. Of the 7, two patients died, one after embolization an d one after surgery. Two of the three surgically-treated cases an stil l alive several years after operation. From this experience we feel th at surgery for gastrointestinal bleeding in acute GVHD is indicated on ly when medical treatment fails. Severe neutropenia, thrombocytopenia (<10.000 x mm(3)) and blood cultures positive for CMV have an unfavora ble prognostic value.