High incidence of gastrointestinal tract bleeding after autologous stem cell transplant for primary systemic amyloidosis

Peripheral blood stem cell transplants have been associated with better res ponse rates than conventional chemotherapy in patients with primary systemi c amyloidosis. A higher incidence of gastrointestinal (GI) tract bleeding h as been observed among amyloidosis patients undergoing peripheral stem cell transplantation. We retrospectively reviewed the medical records of such p atients to identify those who had GI tract bleeding in the post-transplant period. Forty-five patients were studied. Nine patients had GI tract bleedi ng in the posttransplant period. The median post-transplant duration to ons et of bleeding was 9.5 days (range 1 to 48 days). Three patients had lower GI tract bleeding, two had upper GI tract bleeding, and four had both. Diff use esophagitis and gastritis were the most common findings on endoscopy. T here were no correlations among the age, platelet nadir, or CD34 count of t he graft and the risk of bleeding. Women were more likely to have GI tract bleeding (P = 0.015), as were patients with slow platelet engraftment (P = 0.02). Patients with multiorgan involvement and those on hemodialysis appea red to be at a higher risk of GI tract bleeding. The mean posttransplant ho spital stay for those with GI tract bleeding was 37 days compared with 14.5 days for those who did not have GI tract bleeding (P = 0.0047).