Prospective evaluation for upper gastrointestinal tract acute graft-versus-host disease after hematopoietic stem cell transplantation

The incidence and clinical significance of upper gastrointestinal tract acu te graft-versus-host disease (upper GI GVHD) were prospectively evaluated i n 44 Japanese patients who underwent allogeneic (n = 26) or autologous (n = 18) stem cell transplantation. Endoscopic examination was routinely perfor med between days 20 and 50 post-transplant and when symptoms of upper GI an d/or acute GVHD of other organs were present, The results were compared wit h the historical records of 49 allograft and 20 autograft recipients. The d iagnosis of upper GI GVHD was confirmed by histologic findings of GVHD and persistent upper GI tract symptoms. The incidence of upper GI GVHD was 46% in the prospective allograft group, higher than in the retrospective group. Upper GI GVHD was not diagnosed in any autograft patients. Twelve of 19 pa tients with upper GI GVHD had skin GVHD, and two of the 12 had concurrent l ower GI GVHD, Upper GI GVHD was successfully treated with steroids and did not progress to symptomatic lower GI GVHD, In addition, upper GI GVHD compl etely resolved without specific alteration in immunosuppressant therapy in six patients. No risk factors for upper GI GVHD could be identified. The pr esence of upper GI GVHD did not significantly affect early death rate, inci dence of chronic GVHD, and overall survival. In conclusion, by the prospect ive evaluation of the upper GI tract by endoscopy we could accurately diagn ose upper GI GVHD in half our allogeneic recipients. However, upper GI GVHD was successfully controlled with or without additional steroids in all cas es and had little impact on transplant outcome.