Alimentary TractCourse of Crohn's disease after allogeneic marrow transplantation☆,☆☆
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).
Empty Cell Patients Empty Cell 1 2 3 4 5 6 Unique patient no. 1644 4405 4443 5178 6215 7123 CD before transplantation Age at onset (yr) 16 22 18 32 34 17 Complications Renal stone (calcium oxalate) Ileocolic fistula Ileocolonic 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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2016, Biology of Blood and Marrow TransplantationCitation Excerpt :Although limited by the small number of patients with this rare condition, our results suggest that HSCT should not be contraindicated if IBD alone is considered a comorbidity. Furthermore, it should be kept in mind that that the overall prognosis of these patients with secondary myelodysplastic syndrome/acute myelogenous leukemia remains dismal in the absence of allogeneic HSCT that eventually could also cure IBD [9,10]. Autologous HSCT is currently proposed in patients with severe IBD resistant to other treatments with the aim of resetting the immune system and generating new self-tolerant lymphocytes.
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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.