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Histologic analysis has a prognostical value in colorectal biopsies assessed for suspicion of graft-versus-host disease

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Abstract

Gastrointestinal (GI) graft-versus-host-disease (GVHD) is a common and severe complication of allogeneic hematopoietic stem cell transplantation, but clinical and histological features are unspecific. The aim of this study was to correlate the histological GI GVHD grade with the clinical outcomes. In a retrospective study of 112 patients with clinically suspected GI GVHD, colonic biopsies were reviewed by three pathologists without knowledge of the corresponding clinical data and classified in four scores, according to the NIH Consensus Project recommendations: no GVHD, possible, probable, and unequivocal GVHD. At the end of the study, the histological and clinical data were confronted with the following results: clinical diagnosis of GI GVHD was established for 70 patients (62.5%) and histological scores correlated well with the clinical diagnosis (p < 0.001) and particularly with the prognosis (p < 0.05).When severe lesions were observed, the 1 year overall survival declined to 9%. None of the features reported in the literature to support GVHD diagnosis, eosinophil count, endocrine cells aggregate, immunohistochemical analysis (cytomegalovirus, CD123, chromogranin), did not help us for diagnosis. So routine histopathology alone without immunohistochemistry is a strong and reproducible tool to diagnose GI GVHD with the help of clinical and biological information, and most importantly, histological grading proved to be a powerful prognostic value.

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Abbreviations

AB:

Apoptotic body

CMV:

Cytomegalovirus

GI:

Gastrointestinal

GVHD:

Graft versus host disease

H&E:

Hematoxylin eosin

HES:

Hematoxylin eosin saffron

HPF:

High power field

HSCT:

Hematopoietic stem cell transplantation

MMF:

Mycophenolate mofetil

NC:

Non contributory

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Authors and Affiliations

  1. Department of Pathology, University Hospital of Bordeaux, Haut-Lévêque Hospital, Avenue de Magellan, 33604, Pessac, France

    Fanny Sauvestre, Geneviève Belleannée, Harold IpKan Fong, Jean-François Goussot & Marion Marty

  2. Department of Hematology, University Hospital of Bordeaux, Haut-Lévêque Hospital, Pessac, France

    Claire Bréal, Catherine Mohr, Reza Tabrizi, Noël Milpied & Stéphane Vigouroux

  3. ISPED, Population Health, University of Bordeaux, Bordeaux, France

    Sébastien Cossin

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  1. Fanny Sauvestre
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Correspondence to Fanny Sauvestre.

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Sauvestre, F., Belleannée, G., Bréal, C. et al. Histologic analysis has a prognostical value in colorectal biopsies assessed for suspicion of graft-versus-host disease. Virchows Arch 472, 213–220 (2018). https://doi.org/10.1007/s00428-017-2272-2

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  • DOI: https://doi.org/10.1007/s00428-017-2272-2

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