Diarrhea after cord blood HSCT may be attributable to cord colitis syndrome

Herrera AF. N Engl J Med. 2011;365:815-824.

  • HemOnc Today, October 10, 2011

Physicians should consider cord colitis syndrome as a possible cause in patients who have undergone umbilical cord blood hematopoietic stem cell transplantation, according to the results of a respective cohort study.

Physicians at the Dana-Farber Cancer Institute/Brigham and Women’s Hospital Hematopoietic Stem Cell Transplantation (HSCT) Service examined 104 patients who underwent cord blood HSCT from 2003 to 2010. Three patients received 1 unit of blood and 101 patients received 2 units. The median follow-up was 452 days.

Researchers defined cord colitis syndrome as persistent diarrheal illness lasting at least 7 days in a patient undergoing cord blood HSCT that was not caused by acute graft-versus-host disease (GVHD), bacterial or viral infection, post-transplantation lymphoproliferative disease or another identifiable cause on microbiologic and histopathological examination.

Eleven patients (10.6%) were diagnosed with cord colitis syndrome, and seven of those patients had granulomas as found in biopsy specimens of the stomach, duodenum and colon. One-year cumulative probability of a patient meeting the case definition for cord colitis syndrome was 0.16. Median time to onset of the syndrome was 131 days after cord blood transplantation.

Clinically driven microbiologic evaluations during episodes of the cord colitis syndrome, including stool Clostridium difficile toxin assays and testing for protozoa and parasites conducted on all 11 patients, were negative. Researchers found no connection between occurrence of the syndrome and age, race, primary hematologic disease, conditioning regimen or GVHD prophylactic regimen used.

Researchers determined that the main feature distinguishing the cord colitis syndrome from acute GVHD is the histopathological finding of chronic active colitis associated with granulomas. The histologic hallmark of acute GVHD in the gastrointestinal tract is increased apoptosis.

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