PMID- 38052367
OWN - NLM
STAT- MEDLINE
DCOM- 20240415
LR  - 20240415
IS  - 2666-6367 (Electronic)
IS  - 2666-6367 (Linking)
VI  - 30
IP  - 4
DP  - 2024 Apr
TI  - Non-Graft-versus-Host Disease Enterocolitis Following Cord Blood Transplantation 
      is Real, with Poorly Understood Pathophysiology, and Requires Distinct 
      Management, with Eventual Resolution without Immune Suppression.
PG  - 440.e1-440.e9
LID - S2666-6367(23)01712-8 [pii]
LID - 10.1016/j.jtct.2023.11.023 [doi]
AB  - Enterocolitis is common after cord blood transplantation (CBT) and a specific, 
      non-graft-versus-host disease (GVHD) entity with specific histopathologic 
      features ("cord colitis") has been described in some cases in selected series. 
      Immune suppression is not without risk, and we have used it only when biopsy 
      features are consistent with classical GVHD. In the absence of biopsy features of 
      classical GVHD, our management of intestinal failure has been supportive, and we 
      have withdrawn immune suppression to allow immune reconstitution and better 
      prevent relapse of malignant disease and reduce infectious complications. We 
      evaluated our approach over an 11-year period in a retrospective study of all 
      patients at our large pediatric CBT center who experienced intestinal failure 
      necessitating endoscopy and biopsy in the post-CBT period. We conducted a blinded 
      histopathologic review of gastrointestinal (GI) biopsy specimens from all 
      patients who had undergone GI endoscopy for intestinal failure in the post-CBT 
      period. Patient records were evaluated to determine clinical HSCT course and 
      outcome data, including mortality, relapse, and infection, as well as the 
      duration of immune suppression and parenteral nutrition. Out of 144 patients who 
      underwent CBT during the study period, 25 (17%) experienced intestinal failure 
      requiring endoscopy. Thirteen patients were diagnosed with acute GVHD after 
      blinded review of biopsy specimens, and 12 patients had non-GVHD enterocolitis. 
      Management in the absence of GVHD on GI biopsy is supportive, with withdrawal of 
      immune suppression in patients with malignant disease and continuing in 
      accordance with institutional practice in those with nonmalignant disease. 
      Compared with the GVHD cohort, the non-GVHD enterocolitis cohort had superior 
      overall survival (91% versus 41%; P = .04) and a shorter duration of immune 
      suppression (mean, 112 days versus 180 days; P = .049), reflecting these 
      different management approaches. These results demonstrate that different 
      histopathologic findings in those with intestinal failure after CBT likely 
      indicates a different etiology from GVHD and mandates a different clinical 
      management strategy to achieve optimal clinical outcomes.
CI  - Copyright (c) 2023 The American Society for Transplantation and Cellular Therapy. 
      Published by Elsevier Inc. All rights reserved.
FAU - Horgan, Claire
AU  - Horgan C
AD  - Department of Paediatric Bone Marrow Transplant and Cellular Therapy, Royal 
      Manchester Children's Hospital, Manchester University NHS Foundation Trust, 
      Manchester, United Kingdom.
FAU - Bitetti, Stefania
AU  - Bitetti S
AD  - Department of Paediatric Histopathology, Royal Manchester Children's Hospital, 
      Manchester University NHS Foundation Trust, Manchester, United Kingdom.
FAU - Newbould, Melanie
AU  - Newbould M
AD  - Department of Paediatric Histopathology, Royal Manchester Children's Hospital, 
      Manchester University NHS Foundation Trust, Manchester, United Kingdom.
FAU - Sethuraman, Chitra
AU  - Sethuraman C
AD  - Department of Paediatric Histopathology, Royal Manchester Children's Hospital, 
      Manchester University NHS Foundation Trust, Manchester, United Kingdom.
FAU - Fagbemi, Andrew
AU  - Fagbemi A
AD  - Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, 
      Manchester University NHS Foundation Trust, Manchester, United Kingdom.
FAU - Kala, Adnan
AU  - Kala A
AD  - Department of Paediatric Gastroenterology, Royal Manchester Children's Hospital, 
      Manchester University NHS Foundation Trust, Manchester, United Kingdom.
FAU - Williams, Nicola
AU  - Williams N
AD  - Department of Paediatric Bone Marrow Transplant and Cellular Therapy, Royal 
      Manchester Children's Hospital, Manchester University NHS Foundation Trust, 
      Manchester, United Kingdom.
FAU - Wynn, Robert
AU  - Wynn R
AD  - Department of Paediatric Bone Marrow Transplant and Cellular Therapy, Royal 
      Manchester Children's Hospital, Manchester University NHS Foundation Trust, 
      Manchester, United Kingdom. Electronic address: robert.wynn@mft.nhs.uk.
LA  - eng
PT  - Journal Article
DEP - 20231203
PL  - United States
TA  - Transplant Cell Ther
JT  - Transplantation and cellular therapy
JID - 101774629
SB  - IM
MH  - Child
MH  - Humans
MH  - *Cord Blood Stem Cell Transplantation/adverse effects
MH  - Retrospective Studies
MH  - *Intestinal Failure
MH  - Neoplasm Recurrence, Local/complications
MH  - *Hematopoietic Stem Cell Transplantation/adverse effects
MH  - *Graft vs Host Disease/etiology
MH  - Endoscopy, Gastrointestinal/adverse effects/methods
MH  - *Enterocolitis/etiology/complications
MH  - Chronic Disease
MH  - Recurrence
OTO - NOTNLM
OT  - Cord blood transplantation
OT  - Cord colitis
OT  - Enterocolitis
OT  - GVHD
EDAT- 2023/12/06 03:43
MHDA- 2024/04/15 06:42
CRDT- 2023/12/05 19:21
PHST- 2023/08/19 00:00 [received]
PHST- 2023/11/14 00:00 [revised]
PHST- 2023/11/28 00:00 [accepted]
PHST- 2024/04/15 06:42 [medline]
PHST- 2023/12/06 03:43 [pubmed]
PHST- 2023/12/05 19:21 [entrez]
AID - S2666-6367(23)01712-8 [pii]
AID - 10.1016/j.jtct.2023.11.023 [doi]
PST - ppublish
SO  - Transplant Cell Ther. 2024 Apr;30(4):440.e1-440.e9. doi: 
      10.1016/j.jtct.2023.11.023. Epub 2023 Dec 3.