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Characterization of Esophageal Biopsies from Stem Cell Transplant Patients With and Without Esophageal
Reem Youssef1, Omer Saeed1, Jingmei Lin1
1Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Abstract:
Graft-versus-host disease (GVHD) is a major complication of hematopoietic stem cell transplantation (HSCT). Histologic diagnostic criteria and several grading systems have been described for colonic GVHD; however, for esophageal GVHD (eGVHD) limited reports exist to date. In this study, a total of 130 patients with esophageal biopsies of HSCT were included, with a median age of 44 years (2-77 years) and a male predominance (54.6%). Of these, 82 (63%) had a clinical diagnosis of eGVHD. Cases were divided into 2 groups: those without apoptotic bodies, dyskeratotic cells, or ulceration (group 1, no histologic evidence of eGVHD) (42%) and those with at least one of those features (group 2) (58%). Group 2 cases were associated with extragastrointestinal tract GVHD (P = .024), a clinical diagnosis of eGVHD (P = .001), older age (P < .001), stem cells derived from peripheral blood (P < .001), higher number of intraepithelial lymphocytes (P = .002), presence of acute inflammation (P < .001), and basal cell hyperplasia (P = 0.016). Apoptotic bodies were seen in 65 (89%), dyskeratotic cells in 27 (37%) and an ulcer in 28 (37%) of the group 2 cases. The sensitivity (Sn), specificity (Sp), and accuracy (acc) of the group 2 cases for a clinical diagnosis of eGVHD was 68.3%, 60.4%, and 65.4%, respectively. Apoptotic bodies (P = .012) and dyskeratotic cells (P < .001) but not ulceration (P = .881), were associated with a clinical diagnosis of eGVHD. The Sn, Sp, and acc for apoptotic bodies, dyskeratotic cells, and ulcer were 59.3%, 63.8% and 60.9%; 30.9%, 95.7%, and 54.7%; and 21.9%, 79.2%, and 43.1%, respectively. Cases with only apoptotic bodies or ulceration were considered as possible GVHD, and those with dyskeratotic cells as likely GVHD, which were associated with GVHD-specific survival (P = .030). This study provides a comprehensive characterization of the esophageal histologic findings in patients with HSCT. Further studies are needed to corroborate these findings in other patient populations.
