Late-onset colitis after cord blood transplantation is consistent with graft-versus-host disease: results of a blinded histopathological review.
Cord colitis syndrome after umbilical cord blood transplantation (UCBT) involves late-onset diarrhea, absence of infection or GVHD, chronic active colitis, and granulomatous inflammation that responds to antibiotics. We tested the hypothesis that Seattle recipients of UCBT had late-occurring colitis distinct from GVHD and colitis in other allograft recipients. We conducted a blinded histological review of 153 colon biopsy specimens from 45 UCBT recipients and 45 matched allografted controls obtained between day +70 and day +365 post-transplantation. Diarrhea was the primary indication for biopsy in 10 UCBT recipients and 11 controls. No histological differences were seen between UCBT recipients and controls with diarrhea or between the entire cohort of UCBT recipients and their controls. Distorted mucosal architecture and apoptotic crypt cells typical of GVHD were common in both groups; Paneth cell metaplasia and granulomas were rare findings. Chronic active colitis was present in 58% of the UCBT recipients and in 62% of controls. No UCBT recipient with diarrhea was treated with antibiotics, and all recipients responded to systemic corticosteroids. Colitis occurring after day +70 in allografted controls was related to acute GVHD, independent of the source of donor cells. We could not identify a histologically distinct cord colitis syndrome in either the UCBT or the non-cord blood allograft recipients.
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Departments of Pediatrics, Pathology, and Medicine, University of Washington School of Medicine, Seattle, Washington. Electronic address: fmilano@fhcrc.org.
Filippo
F
Milano
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Departments of Pediatrics, Pathology, and Medicine, University of Washington School of Medicine, Seattle, Washington.
Howard M
HM
Shulman
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Public Health Sciences Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Katherine A
KA
Guthrie
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.
Ivy
I
Riffkin
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Departments of Pediatrics, Pathology, and Medicine, University of Washington School of Medicine, Seattle, Washington.
George B
GB
McDonald
Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Departments of Pediatrics, Pathology, and Medicine, University of Washington School of Medicine, Seattle, Washington.
Colleen
C
Delaney
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D003092:Colitis / Q000209:etiology* / Q000473:pathology; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods*; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology* / Q000473:pathology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D055815:Young Adult
Cord blood transplant; Cord colitis syndrome; Gut graft-versus-host disease