Gastroenterology

Gastroenterology

Volume 114, Issue 3, March 1998, Pages 433-440
Gastroenterology

Alimentary Tract
Course of Crohn's disease after allogeneic marrow transplantation,☆☆

https://doi.org/10.1016/S0016-5085(98)70525-6Get rights and content

Abstract

Background & Aims: Remission of several autoimmune diseases has been described after allogeneic marrow transplantation. The aim of this study was to determine if the natural history of Crohn's disease was altered by hematopoietic cell transplants from healthy allogeneic donors. Methods: Between 1982 and 1992, 6 patients with Crohn's disease and leukemia underwent allogeneic marrow transplantation and were followed up clinically. Results: Five patients had active Crohn's disease before transplantation, and 3 had clinical evidence of sclerosing cholangitis. Four marrow donors were HLA-identical siblings, 1 related donor was mismatched at the DR locus, and 1 unrelated donor was HLA-matched. One patient died of septicemia 97 days after transplantation; 5 patients were observed for 4.5, 5.8, 8.4, 9.9, and 15.3 years after transplantation. Four of 5 patients evaluated had no signs or symptoms of Crohn's disease after transplantation. One patient with mixed donor-host hematopoietic chimerism had a relapse of Crohn's disease 1.5 years after transplantation. Conclusions: Four of 5 patients followed up for 4.5 to 15.3 years after allogeneic hematopoietic cell transplantation remained free of Crohn's disease. These observations suggest that host immune dysregulation plays a role in the perpetuation of Crohn's disease that can be corrected by allogeneic hematopoietic cell transplantation.

GASTROENTEROLOGY 1998;114:433-440

Section snippets

Technique of marrow transplantation

The methods of allogeneic marrow transplantation at our center have been described previously.25 All patients received high-dose cytoreductive therapy with cyclophosphamide (120 mg/kg) and supralethal total body irradiation (12–13.5 Gy). By convention, the day of unmodified marrow infusion is termed day zero. T-cell depletion of the marrow was not used. Patients were treated with the following agents to prevent acute graft-versus-host disease (GVHD): methotrexate to day 11 and cyclosporine to

Patient 1

A boy developed Crohn's ileocolitis at age 16, documented after 7 months of symptoms by intestinal contrast radiographs and histology of mucosal biopsy specimens taken at colonoscopy (Table 1).

. Summary of patients with Crohn's disease who underwent allogeneic marrow transplantation

Empty CellPatients
Empty Cell123456
Unique patient no.164444054443517862157123
CD before transplantation
 Age at onset (yr) 16 22 18 32 34 17
 ComplicationsRenal stone (calcium oxalate)Ileocolic fistulaIleocolonic resection Perianal fistula Renal

Discussion

The posttransplant course showed absence of signs and symptoms of Crohn's disease for 4.5–15.3 years after transplantation in 4 of the 5 evaluable patients. Normalization of serum alkaline phosphatase levels was noted in 2 of 3 patients with a clinical diagnosis of sclerosing cholangitis; both patients had the HLA-DRw52 haplotype previously reported in a cohort of patients with sclerosing cholangitis.29 In contrast to the course of our patients, clinical series suggest that most patients with

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    ☆☆

    Supported by grants CA18029, CA47748, CA15704, HL36444, and CA18221 from the National Institutes of Health. Dr. Otero Lopez-Cubero was supported by the Hospital Virgen del Rocio, Seville, Spain.

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