Severe gastrointestinal bleeding after hematopoietic cell transplantation,1987-1997: Incidence, causes, and outcome

OBJECTIVE: Severe GI bleeding after hematopoietic cell transplantation is c ommonly due to lesions that are unusual in nontransplant patients. The freq uency of GI bleeding appears to have decreased over the last decade, but th e reasons have not been readily apparent. We sought to determine the incide nce of severe bleeding during two time periods, to describe the causes and outcomes of bleeding, and to analyze the reasons behind an apparent decline in severe bleeding over the decade covered. METHODS: During 1986-1987 and 1996-1997, we: followed all patients with and without severe bleeding at our institution, a marrow transplant center. RESULTS: Over this decade, the incidence of severe bleeding declined from 5 0/467 (10.7%) to 15/635 (2.4%) (p < 0.0001). Overall mortality from intesti nal bleeding declined from 3.6% to 0.9% (p = 0.002), but mortality in those with bleeding remained high (34% vs 40%). The onset (day 42 vs 47) and pla telet counts (35,994 vs 37,600/<mu>l) were similar, but the sites and cause s of bleeding were different. During 1986-1987, 27/50 patients bled from mu ltiple GI sites, viral and fungal ulcers, or graft-versus-host disease (GVH D). Over the decade, bleeding from GVHD had decreased 80% (p < 0.0001), and bleeding from viral (p < 0.0001) and fungal (p = 0.023) ulcers almost disa ppeared. CONCLUSIONS: The incidence of severe GI bleeding has declined significantly over the last decade because of prevention of viral and fungal infections and severe acute GVHD. However, severe bleeding after transplant remains a highly morbid event, particularly among patients with GVHD.