Expertos Invitados





IMPLICACIONES DIGESTIVAS DE LA ENFERMEDAD DEL INJERTO CONTRA EL HUESPED

(especial para SIIC © Derechos reservados)
El diagnóstico de certeza de la enfermedad del injerto contra el huésped en el tracto gastrointestinal se hace mediante el examen histológico de la mucosa gástrica o rectal. No hay medidas específicas que permitan prevenirla y su tratamiento se basa en el uso de corticoides asociados a otros agentes.
ecarreras.jpg Autor:
Enric Carreras pons
Columnista Experto de SIIC
Artículos publicados por Enric Carreras pons
Coautor
Juan Duque Ortega* 
Doctor en Medicina, Unidad de Trasplante Hematopoyético, Servicio de Hematología, Hospital Clínic*
Recepción del artículo
8 de Abril, 2003 		Primera edición
14 de Julio, 2003 		Segunda edición, ampliada y corregida
7 de Junio, 2021

IMPLICACIONES DIGESTIVAS DE LA ENFERMEDAD DEL INJERTO CONTRA EL HUESPED

Resumen
El transplante alogénico de progenitores hematopoyéticos (TPH) conlleva riesgo importante de complicaciones del tracto gastrointestinal que se originan a partir de la quimiorradioterapia del acondicionamiento, las infecciones y la aparición de enfermedad injerto contra el huésped (EICH). Se han descrito dos formas de EICH, aguda y crónica. La EICH aguda se caracteriza por aparecer durante los 100 primeros días del TPH, siendo la principal causa de muerte en más del 20% de los pacientes. Afecta el intestino, la piel y el hígado. La EICH crónica es una afección multisistémica que puede aparecer luego de una forma aguda, después de su resolución, o bien surgir de novo. Se presenta hasta en el 60% de los sobrervivientes a largo plazo. Su clínica y alteraciones anatomopatológicas se asemejan a diversas enfermedades autoinmunes, con compromiso de piel, boca, hígado, ojos, esófago y aparato respiratorio, siendo excepcional la afección del tracto gastrointestinal. El diagnóstico de certeza de EICH intestinal se hace mediante el examen histológico de la mucosa gástrica o rectal. No hay medidas específicas que permitan prevenir la EICH intestinal, y su tratamiento se basa en el uso de corticoides asociados a otros agentes inmunosupresores.

Palabras clave
Enfermedad injerto contra huésped, rechazo intestinal


Artículo completo
(castellano)
Extensión:  +/-7.51 páginas impresas en papel A4
Exclusivo para suscriptores/assinantes

Abstract
Allogeneic stem cell transplantation implies an important risk of gastrointestinal complications because of chemoradiotherapy conditioning, infections and graft vs host disease (GVHD).There are two forms of GVHD, acute and chronic. Acute-GVHD appears before the 100th day of transplantation, and is the first cause of death in about 20% of patients. Acute GVHD involves the gastrointestinal tract, skin and liver. Chronic GVHD is a multisystemic disease that appears following an acute form, after the latter has been cured, or as de novo form. Chronic GVHD occurs in 60% of the long term survivors, its clinical signs and pathologic findings usemble an autoimmune disease, with skin, mouth, liver, eyes, esophagus and respiratory compromise; involvement of the intestinal tract is exceptional. The diagnosis is based on gastrontestinal biopsy (gastric or rectal). There are no specific prophylactic measures, and the treatment is based on prednisone and other immunosuppressors agents.

Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Hematología
Relacionadas: Gastroenterología, Hematología



Comprar este artículo
Extensión: 7.51 páginas impresas en papel A4

file05.gif (1491 bytes) Artículos seleccionados para su compra



Bibliografía del artículo
  1. Strasser SI, Mc Donald GB. Gastrointestinal and hepatic complications. In: Thomas ED, Blume KG, Forman SJ, eds. Hematopoietic cell transplantation. Malden: Blackwell Science. Inc., 1998; 627-658.
  2. Bensinger WI, Buckner CD. Preparative regimens. In: Thomas ED, Blume KG, Forman SJ, eds. Hematopoietic cell transplantation. Malden: Blackwell Science. Inc., 1998; 123-134.
  3. Sullivan KM. Graft versus host disease. In: Thomas ED, Blume KG, Forman SJ, eds. Hematopoietic cell transplantation. Malden: Blackwell Science. Inc., 1998; 515-536.
  4. Goker H, Haznedaroglu IC, Chao NJ. Acute graft versus host disease: Pathobiology and management. Exp Hematol 2001; 29: 259-277.
  5. Ferrara JLM, Antin JH. The pathophysiology of graft versus host disease. In: Thomas ED, Blume KG, Forman SJ, eds. Hematopoietic cell transplantation. Malden: Blackwell Science. Inc., 1998; 305-315.
  6. Billingham RE. The biology of graft versus host reactions. The Harvey lectures. Vol 62. Nueva York: Academic Press, 1966; 21-78.
  7. Gluckman E, Rocha V, Boyer-Chammard A, Locatelli F, Arcese W, Pasquini R et al. Outcome of cord-blood transplantation from related and unrelated donors. N Engl J Med 1996; 337: 373-381.
  8. Schmitz N, Bacigalupo A, Labopin M, Majolino M, Laporte JP, Brinch L et al. Transplantation of peripheral blood progenitors from HLA-identical sibling donors. Br J Haematol 1996; 95: 715-723
  9. Jamieson NV, Joysey V, Friend PJ, Marcus R, Ramsbottom S, Baglin T et al. Graft versus host disease in solid organ transplantation. Transplant Int 1991; 4: 67-71.
  10. Anderson KC, Weinstein HJ. Transfusion-associated graft versus host disease. N Engl J Med 1990; 323: 315-321.
  11. Juji t, Takahashi K, Shibata Y, Ide H, Sakakibara T, Ino T et al. Post-transfusion grafo versus host disease in immunocompetent patients alter cardiac surgery in Japan. N Engl J Med 1989; 321:356.
  12. Teshima T, Ferrara JLM. Understanding the alloresponse: new approaches to graft versus host disease prevention. Semin Hematol 2002; 39: 15-22.
  13. Vogelsang GB, Hess AD. Graft versus host disease: new directions for a persistent problem. Blood 1994; 84: 2061-2067.
  14. Chao NJ. Graft versus host disease: the viewpoint from the donor cell. Biol Blood Marrow Transplant 1997; 3: 1-10.
  15. Xung CQ, Thomson JS, Jennings CD, Brown SA, Widmer MB. Effect of total body radiation, busulfan-cyclophosphamide, or cyclophosphamide conditioning on inflammatory cytokine release and development of acute and chronic graft versus host disease in H-2 incompatible transplanted SCID mice. Blood 1994; 83: 2360-2367.
  16. Pober JS, Gimbrone MAJr, Lapierre LA, Mendrick DL, Fiers W, Rothlein R et al. Overlaping patterns of activation of human endothelial cells by interleukin 1, tumor necrosis factor, and immune interferon. J Immunol 1986; 137: 1893-1896.
  17. Hill GR, Crawford JM, Cooke KKR, Brinson YS, Pan L, Ferrara JL. Total body irradiation and acute graft versus host disease: the role of gastrointestinal damage and inflammatory cytokines. Blood 1997; 90: 3204-3213.
  18. Goulmy E, Schipper R, Pool J, Blokland E, Falkenburg JH, Vossen J et al. Mismatches of minor histocompatibility antigens between HLA-identical donors and recipients and the development of graft versus host disease after bone marrow transplantation. N Engl J Med 1996; 334: 281-285.
  19. Maruya E, Saji H, Seki S et al. Evidence that CD31, CD49b, and CD62L are immunodominant minor histocompatibility antigens in HLA-identical sibling bone marrow transplant. Blood 1998; 92: 2169.
  20. Sad S, Marcotte R, Mosmann TR. Cytokine-induced differentiation of precursor mouse CD8+ T cell secreting Th1 or Th2 cytokines. Immunity 1995; 2: 271-279.
  21. Nestel FP, Price KS, Seemayer TA, Lapp WS. Macrophage priming and lipopolysacharide-triggered release of tumor necrosis factor alpha during graft versus host disease. J Exp Med 1992; 175: 405-413.
  22. Laster SM, Wood JG, Gooding LR. Tumor necrosis factor can induce both apoptosis and necrotic forms of cell lysis. J Immunol 1988; 141: 2629-2634.
  23. Falzarano G, Krenger W, Snyder KM, Delmonte J, Karandikar M, Ferrara JLM. Suppression of B cell proliferation to lipopolisaccharide is mediated through induction of the nitric oxide pathway by tumor necrosis factor-a in mice with acute graft versus host disease. Blood 1996; 87: 2853-2860.
  24. Ghayur T, Seemayer TA, Kongshawn PAL, Gartner JS, Lapp WS. Graft versus host (GVH) reactions in the beige mouse: An investigation of the role of host and donor natural killer cells in the pathogenesis of GVH disease. Transplantation 1987; 44: 261-267.
  25. Parkman R. Chronic graft-versus-host disease. Curr Opin Hematol. 1998; 5: 22-25
  26. Rozman C, Grañena A, Carreras E, Marin P, Palou J, Mascaro JM et al. Enfermedad del injerto contra el huésped. Análisis de 131 casos de transplante de médula ósea. Med Clin (Barc) 1987; 89: 89-94.
  27. Przepiorka D, Weisdorf D, Martin P, Klingeman HG, Beatty P, Hows J et al. Consensus conference on acute GVHD grading. Bone Marrow Transplant 1995; 15: 825-828.
  28. Wingar JR, Vogelsang GB, Deeg HJ. Stem cell transplantation: Supportive care and long-term complications. In: American Society of Hematology ed. Hematology 2002: Education program book. 2002
  29. Mc Donald GB, Sullivan KM, Schuffler MD, Schulman HM, Thomas ED. Esophageal abnormalities in chronic graft versus host disease in humans. Gastroenterology 1981; 80: 914-921.
  30. Akpek G, Zahurak ML, Piantadosi S, et al. Development of a prognostic model for grading chronic graft-versus-host disease. Blood. 2001; 97: 1219-1226.
  31. Epstein RJ, Mc Donald GB, Sale GE, Shulman HM, Thomas ED. The diagnostic accuracy of rectal biopsy in graft versus host disease: a prospective study of thirteen patients. Gastroenterology 1980; 78:764-791.
  32. Cox GJ, Matsui SM, Lo RS, Hinds M, Browden RA, Hakman RC et al. Etiology and outcome of diarrhea after marrow transplantation: a prospective study. Gastroenterology 1994; 17: 1398-1407.
  33. Weisdorf DJ, Snover DC, Haake R, Miller WJ, Mc Glave PB, Blazer B et al. acute upper gastrointestinal graft versus host disease: clinical significance and response to immunosuppressive therapy. Blood 1990; 76: 624-629.
  34. Spencer GD, Hackamn RRC, Mc Donald GB, Amos DE, Cunningham BA, Meyers JD et al. A prospective study of unexplained nausea and vomiting after marrow transplantation. Transplantation 1986; 42:602-607.
  35. Wu D, Hockenbery DM, Brentnall TA, Naehr PH, Ponec RJ, Kuver R et al. Persistent nausea and anorexia after marrow transplantation. A prospective study of 78 patients. Transplantation 1998; 66: 1319-1324.
  36. Weisdorf SA, Salati LM, Longsdorf JA, Ramsay NK, Sharp HL. Graft versus host disease of the intestine. A protein-losing enteropaty characterized by fecal alpha1-antitrypsin. Gastroenterology 1983; 85: 1076-1081.
  37. Belli AM, Williams MP. Graft versus host disease: findings of plain abdominal radiography. Clin Radiol 1988; 39: 262-264.
  38. Jones B, Fishman EK, Kramer SS, Siegelman SS, Saral R, Beschorner WE et al. Computed tomography of gastrointestinal inflammation after marrow transplantation. Am J Roentgenol 1986; 146: 691-696.
  39. Worawattanakul S, Semelka RC, Kelekis NL, Sallah AS. MR findings of intestinal graft versus host disease. Magn Reson Imaging 1996; 14: 1221-1223.
  40. Sale GE, Shulman HM, Hackman RC. Pathology of hematopoietic cell transplantation. In: Thomas ED, Blume KG, Forman SJ, eds. Hematopoietic cell transplantation. Malden: Blackwell Science. Inc., 1998; 248-263.
  41. Klein SA, Martin H, Schreiber-Dietrich D, Hermann S, Caspary WF et al. A new approach to evaluating intestinal acute graft versus host disease by transabdominal sonography and colour Doppler imagin. Br J Haematol 2001; 115: 929-934.
  42. Haber HP, Schlegel PG, Dette S, Ruck P, Klingebiel T, Niethammer D. Intestinal acute graft versus host disease: findings on sonography. Am J Roentgenol 2000; 174: 118-120.
  43. Fisk JD, Shulman HM, Greening RR, Mc Donald GB, Sale GE, Thomas ED. Gastrointestinal radiographic features of human graft versus host disease. Am J Roentgenol 1981; 136: 329-336.
  44. Bombi JA, Nadal A, Carreras E, Ramirez J, Muñoz A, Rozman C et al. Assesment of histopathologic changes in the colonic biopsy in acute grafo versus host disease. Am J Clin Pathol 1995; 103: 690-695.
  45. Roy J, Snover D, Weisdorf S, Mulvahill A, Filipovich A, Weisdorf D. Simultaneous upper and lower endoscopic biopsy in the diagnosis of intestinal graft versus host disease. Transplantation 1991; 51:642-646.
  46. Snover DC, Weisdorf SA, Vercellotti GM, Rank B, Hutton S, Mc Glave P. A histopathologic study of gastric and small intestine graft versus host disease following allogeneic bone marrow transplantation. Human Pathol 1985; 16: 387-392.
  47. Ponec RJ, Hackman RC, Mc Donald GB. Endoscopic and histologic diagnosis of intestinal graft versus host disease after marrow transplantation. Gastrointest Endosc 1999; 49: 612-621.
  48. Washington K, Bentley RC, Green A, Olson J, Trem KR, Krigman HK. Gastric graft versus host disease: a blinded histologic study. Am J Surg Pathol 1997; 21: 1037-1046.
  49. Otero Lopez-Cubero S, Sale SE, Mc Donald GB. Acute grafo versus host disease of the esophagus. Endoscopy 1997; 29: s35-s36.
  50. Snover DC. Graft versus host disease of the gastrointestinal tract. Am J Surg Pathol 1990; 14: 101-108.
  51. Snover DC. Mucosal damage simulating acute graft versus host disease in cytomegalovirus colitis. Transplantation 1985; 39: 669-670.
  52. Einsele H, Ehninger G, Hebart H, Weber P, Dette S, Link H et al. Incidence of local CMV infection and acute intestinal GVHD in marrow transplant recipients with severe diarrhoea. Bone Marrow Transplant 1994; 14: 955-963.
  53. Hackman RC, Wolford JL, Gleaves CA, Myerson D, Beauchamp MD, Meyers JD et al. Recognition and rapid diagnosis of upper gastrointestinal cytomegalovirus infection in marrow transplant recipients. A comparison of seven virologic methods. Transplantation 1994; 57: 231-237.
  54. Van Burik JH, Leisenring W, Myerson D, Hackman RC, Shulman HM, Sale GE et al. The effect of prophylactic fluconazole on the clinical spectrum of fungal diseases in bone marrow transplant recipients with special attention to hepatic candidiasis: an autopsy study of 355 patients. Medicine (Baltimore) 1998; 77:246-254.
  55. Beelen DW, Elmaagacli A, Muller KD, Hirche H, Schaefer UW. Influence of intestinal bacterial decontamination using metronidazole and cyprofloxacin or cyprofloxacin alone on the development of acute graft versus host disease after marrow transplantation in patients with hematologic malignancies: final results and long-term follow-up of an open-label prospective randomized trial. Blood 1999; 93: 3267-3275.
  56. Storb R, Prentice RL, Buckner CD, Clift RA, Appelbaum F, Deeg J et al. Graft versus host disease and survival in paqtients with aplastic anemia treated by marrow grafts from HLA-identical siblings. Beneficial effects of protective environment. N Engl J Med 1983; 308: 302-307.
  57. Deeg HJ, Henslee-Downee PJ. Management of acute graft versus host disease. Bone Marrow Transplant 1990; 6: 1-8.
  58. Fleming DR. Graft-vs-Host disease: Whats is the evidence. Evidence-based oncol 2002; 3: 2-6
  59. Basara N, Blau WI, Romer E, Rudolphi M, bischoff M, Kirsten D et al. Mycophenolate mofetil for the treatment of acute and chronic GVHD in bone marrow transplant recipients. Bone Marrow Transplant 1998; 22: 61-65.
  60. Martin P, Schoch G, Fisher L, Byers V, Appelbaum FR, Mc Donald GB et al. A retrospective analysis of therapy for acute graft versus host disease: Secondary treatment. Blood 1991; 77: 1821-1828.
  61. Baehr PH, Levine DS, Bouvier ME, Hockenbery DM, Gooley TA, Stern JG et al. Oral bechlomethasone dipropionate for treatment of human intestinal graft versus host disease. Transplantation 1995; 60: 1231-1238.
  62. Mc Donald GB, Bouvier M, Hockenbery DM, Stern JM, Gooley TA, Farrand A et al. Oral bechlomethasone dipropionate for treatment of intestinal graft versus host disease: a randomized controlled trial. Gastroenterology 1998; 115: 28-35.
  63. Shanahan F. Intestinal graft versus host disease. Gastroenterology 1998; 115: 220-222.
Título español
Resumen
 Palabras clave
 Bibliografía
 Artículo completo
(exclusivo a suscriptores)
 Autoevaluación
  Tema principal en SIIC Data Bases
 Especialidades

  English title
 Abstract
  Key words
Full text
(exclusivo a suscriptores)

Autor 
Artículos
Correspondencia

Patrocinio y reconocimiento
Imprimir esta página
 
 
 
 
 
 
Clasificado en
Artículos originales>
Expertos del Mundo

Especialidad principal:
Hematología


Relacionadas:
Gastroenterología
Hematología
 
 
 
 
 
 
Está expresamente prohibida la redistribución y la redifusión de todo o parte de los contenidos de la Sociedad Iberoamericana de Información Científica (SIIC) S.A. sin previo y expreso consentimiento de SIIC.
ua31618
Home

Copyright siicsalud © 1997-2024 ISSN siicsalud: 1667-9008