| [Objective] To analyze the clinical feature and prognosis of severe intestinal graft-versus-host disease(GVHD) in34case after allogeneic hematopoietic stem cell transplantation(allo-HSCT).[Methods] we studied710patients underwent allo-HSCT from Jan.2007to Jan.2011. A total of34patients who developed into severe intestinal GVHD were analyzed retrospectively.[Result] Thirty-four episodes of severe intestinal GVHD disease occurred(4.79%). The majority of them developed into severe intestinal GVHD average29days(18to210days) after allo-HSCT. All patients underwent secretors diarrhea and spasmodic abdominal pain. Part of the patients underwent gastrointestinal bleeding. Of the34patients18received a colonoscopy. The macroscopic findings in this18patient as follows:the lower colon and ileum mucosa diffuse edema, erythema, shallow ulcers and complete denudation of the local mucosa, and turtle patterns change. The histological findings in this18patients as follows:mucosa chronic inflammation, infiltration of lymphocytes or plasma cells, interstitial edema, decreased glands, epithelial apoptosis crypt cell apoptosis. Of the18patient,6patients complicated by a viral enteritis. Deep ulcers can be found macroscopically. Histologically, we found the viral inclusion bodies or CMV antigen or EBVBER. And the intestinal virus DNA-PCR is positive in the six patients. We use Methylprednisolone(MP), CsA or tacrolimus combined CD25monoclonal antibody and oral budesonide for treatment. Ganciclovir, foscarnet, gammaglobulin, allicin and donor source of the virus-specific CTL have been administrated for the patients complicated viral enteritis.28out of34cases achieved complete response(CR)(82.35%). The median follow-up time is442days(42to1463days).Over survival is52.95%(18/34).10out of28cases received CR died of other complication. The univariate analysis of the factors affecting the outcome by SPSS19.0shows19factors on severe intestinal GVHD was no significant difference in efficacy. HGVHD intestinal GVHD affected the overall survival of the adverse factors(p=0.026).[Conclusion] Colonoscopy as early as possible can help early diagnosis. MP, CsA or tacrolimus and CD25monoclonal antibody have a significant effect for the severe intestinal GVHD. Follow-up treatment of complications can improve the overall survival. |
