Many patients with hematologic malignancies undergo allogeneic hematopoietic stem cell transplantation (alloHSCT), only to experience toxicity and alloimmunological reactions to the donor cells known as graft-versus-host disease (GVHD).

GVHD involving the intestine is a primary cause of morbidity and mortality; therefore, a team of researchers conducted a retrospective analysis of biopsies from 97 patients who had undergone alloHSCT to investigate its manifestations to aid in future diagnosis. Their findings were published in Leukemia & Lymphoma.

The researchers analyzed GVHD diagnosed in 4 sites of the upper gastrointestinal tract: the esophagus, the gastric antrum, the gastric corpus, and the duodenum. Data were from patients who underwent endoscopic evaluation after alloHSCT between 2006 and 2019. Of the 97 patients, 59 had biopsies from all 4 sites of the upper GI tract, and 20 patients underwent biopsies from 3 of the sites (antrum, corpus, and esophagus in 11 patients; duodenum, antrum, and corpus in 8 patients; and duodenum, antrum, and esophagus in 1 patient).

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The researchers found that 48 patients had exhibited histologic signs of GVHD, which covered all histologic grades of acute GVHD. The duodenum was found to exhibit the most histologic signs of GVHD, with significant differences in the antrum and gastric corpus. The esophagus was the second most involved site, again with significant difference between the antrum and the corpus. The gastric antrum and corpus were much less sensitive for signs of GVHD.

“In conclusion, we demonstrated that the diagnostic histological features of GVHD of the upper [GI tract] in patients after alloHSCT were most prevalent in the duodenum and esophagus,” they wrote.

The researchers added that the endoscopic findings of ulcers, erosion, atrophy and white plaques significantly correlated with the histological features of GVHD. Overall mortality was also significantly associated with histological signs in all 4 sites. But the researchers noted that endoscopic and histologic findings were not correlated in all patients. This information could be useful when deciding from where to biopsy in future patients.

The study’s findings are limited by its retrospective design covering 14 years, a time interval in which endoscopic technology may have improved. The researchers also noted that usually the time interval for acute GVHD is 20 to 100 days after alloHSCT. Although most patients in this study underwent biopsy approximately 100 days posttransplant, some did undergo biopsy later than 100 days posttransplant.


Kreft A, Schulze L, Ries I, Schindeldecker M, Neumann H. Histological diagnosis of acute graft-versus-host disease in different sites of the upper gastrointestinal tract with correlation to endoscopic findingsLeuk Lymphoma. Published online November 6, 2022. doi:10.1080/10428194.2022.2142056