Cord Colitis Syndrome in Cord-Blood Stem-Cell Transplantation
Cord Colitis Syndrome in Cord-Blood Stem-Cell Transplantation
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DOI：
10.1056/nejmoa1104959
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发表时间：
2011-09-01
影响因子：
158.5
通讯作者：
Marty, Francisco M.
中科院分区：
文献类型：
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作者：
Herrera, Alex F.;Soriano, Gabriela;Marty, Francisco M.
背景腹泻是造血干细胞移植(HSCT)的常见并发症。HSCT后腹泻的重要原因包括急性移植物抗宿主病(GVHD)、感染和药物治疗。在移植和植入脐带血造血干细胞后，我们观察到一种新的培养阴性、抗生素反应性腹泻综合征，原因不明。方法我们对2003年3月至2010年3月在我中心接受脐带血HSCT的所有患者进行了回顾性队列研究。脐带结肠炎综合征被定义为一种持续性腹泻疾病，这种疾病不是由急性移植物抗宿主病、病毒或细菌感染或其他可识别的原因引起的。结果在本中心接受脐血HSCT的104例患者中，发生脐带性结肠炎综合征11例(10.6%)。符合该综合征病例定义的1年Kaplan-Meier累积概率为0.16。移植后中位发病时间为131天(88~314天)。所有患者都对甲硝唑单独或与氟喹诺酮联合使用10至14天的经验性治疗有反应。11名患者中有5名(45%)在停用抗生素后不久出现复发腹泻，所有复发的患者对重新开始抗生素治疗都有反应。所有脐带结肠炎综合征患者均为慢性活动性结肠炎，其中7例为肉芽肿性炎症(%)。结论脐带结肠炎综合征在临床和组织病理学上有别于脐带血HSCT后急性移植物抗宿主病(GVHD)和其他原因引起的腹泻，在该人群中较为常见。对于不能归因于其他原因的腹泻的患者，应考虑该综合征。
BackgroundDiarrhea is a frequent complication of hematopoietic stem-cell transplantation (HSCT). Important causes of diarrhea after HSCT include acute graft-versus-host disease (GVHD), infections, and medications. After the transplantation and engraftment of hematopoietic stem cells from umbilical-cord blood, we observed a new syndrome of culture-negative, antibiotic-responsive diarrhea not attributable to any known cause.MethodsWe conducted a retrospective cohort study of all patients undergoing cord-blood HSCT at our center between March 2003 and March 2010. The cord colitis syndrome was defined as a persistent diarrheal illness in such patients that was not due to acute GVHD, viral or bacterial infection, or another identifiable cause. Clinical and histopathological features of patients meeting the case definition were further analyzed.ResultsAmong 104 patients who underwent cord-blood HSCT at our center, the cord colitis syndrome developed in 11 (10.6%). The 1-year Kaplan-Meier cumulative probability of meeting the case definition for the syndrome was 0.16. The median time to onset after transplantation was 131 days (range, 88 to 314). All patients had a response to a 10-to-14-day course of empirical therapy with metronidazole, alone or in combination with a fluoroquinolone. Five of the 11 patients (45%) had recurrent diarrhea shortly after discontinuation of antibiotics, and all patients who had a relapse had a response to reinitiation of antibiotic therapy. On histologic examination, all patients with the cord colitis syndrome had chronic active colitis, with granulomatous inflammation present in 7 of 11 patients (64%).ConclusionsThe cord colitis syndrome is clinically and histopathologically distinct from acute GVHD and other causes of diarrhea in patients who have undergone cord-blood HSCT and is relatively common in this patient population. The syndrome should be considered in such patients who have diarrhea that is not attributable to other causes.