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©2012 Baishideng Publishing Group Co.
World J Gastroenterol. Apr 28, 2012; 18(16): 1851-1860
Published online Apr 28, 2012. doi: 10.3748/wjg.v18.i16.1851
Published online Apr 28, 2012. doi: 10.3748/wjg.v18.i16.1851
Table 1 Emetogenic potential of chemotherapeutic agents used in stem cell transplantation
Chemotherapeutic agent | |
High (90%) emetogenic risk | Carmustine > 250 mg/m2 |
Cyclophosphamide > 1500 mg/m2 | |
Moderate (30%-90%) emetogenic risk | Busulfan |
Cytarabine > 200 mg/m2 | |
Melphalan | |
Low (10%-30%) emetogenic risk | Etoposide |
Minimal (< 10%) emetogenic risk | Fludarabine |
Rituximab |
Table 2 Differential diagnosis of post-transplant diarrhea
Conditioning regimen-related | |
Acute GVHD | |
Drug toxicity | |
Antibiotic-related | |
Opioid withdrawal | |
Mycophenolate mofetil toxicity | |
Tacrolimus (thrombotic microangiopathy) | |
Proton pump inhibitors | |
Promotility agents | |
Magnesium salts | |
Metoclopramide | |
Infectious | |
Clostridium difficile | |
CMV | |
Rotavirus | |
Adenovirus | |
EBV | |
HSV | |
Astrovirus | |
Norovirus | |
Bacterial infections including ESBL | |
Fungal infections | |
Parasitic infections (Cryptosporidium, Microsporidia, Giardia) | |
Mycobacterial infections | |
Others | |
Lactose intolerance | |
Malabsorption | |
Pancreatic insufficiency |
Table 3 Staging of acute graft-versus-host disease (modified Keystone criteria)
Stage | Intestinal tract | Liver | Skin |
0 | Diarrhea ≤ 500 mL/d | Bilirubin < 2.0 mg/dL | No rash |
1 | Diarrhea 501-1000 mL/d or nausea (± vomiting) | Bilirubin 2.0-3.0 mg/dL | Maculopapular rash < 25% of body surface |
2 | Diarrhea 1001-1500 mL/d | Bilirubin 3.1–6.0 mg/dL | Maculopapular rash 25%-50% of body surface |
3 | Diarrhea > 1501 mL/d | Bilirubin 6.1–15 mg/dL | Generalized erythroderma |
4 | Severe abdominal pain +/- ileus | Bilirubin > 15 mg/dL | Generalized erythroderma with blister/bullous formation and desquamation |
Table 4 Grading of acute graft-versus-host disease (modified Keystone criteria)
Grade | Gut | Liver | Skin |
0 (none) | 0 | 0 | 0 |
I(mild) | 0 | 0 | 1-2 |
II (moderate) | 1 | 1 or | 3 or |
III (severe) | 2-4 | 2-3 or | 0-3 |
IV (life-threatening) | 4 | 4 or |
Table 5 Differential diagnosis for liver function abnormalities after hematopoietic stem cell transplantation
First 3 wk post-transplant |
Drug toxicity |
Conditioning regimens (cyclophosphamide, total body irradiation, bis-chloroethylnitrosourea, busulfan) |
Calcineurin inhibitors |
Azole antifungals |
SOS |
Sepsis, candidiasis |
Ischemic liver disease |
From 3 wk to 3 mo post-transplant |
Acute GVHD |
Drug toxicity |
SOS |
Hepatitis (fulminant, acute or chronic): |
Viral (HBV, HCV, HSV, VZV, adenovirus) reactivation |
Bacterial or fungal Infection |
Fungal abscess |
Gall bladder disease/cholecystitis |
Hyperalimentation |
Post-transplant lymphoproliferative disorder (EBV-related) |
After 3 mo post-transplant |
Chronic GVHD |
Iron overload |
Chronic viral hepatitis |
Drug toxicity |
Liver fibrosis or cirrhosis: |
SOS |
Viral infections |
Hemosiderosis |
Disease recurrence or new malignancy including hepatocellular carcinoma, lymphoproliferative disorder |
Nodular regenerative hyperplasia |
Gallbladder disease |
Table 6 Risk factors for sinusoidal obstruction syndrome
Existing liver disease: |
Chronic viral hepatitis |
Alcohol related hepatitis |
Steatohepatitis |
Cirrhosis, lobular fibrosis |
Cholestatic disorders |
Extramedullary hematopoiesis with sinusoidal fibrosis |
Prior history of: |
SOS |
Extensive chemotherapy and stem cell transplantation |
Hepatic radiation |
Drugs |
Recent gemtuzumab ozogamicin use |
Conditioning agents: |
High dose TBI (> 14 Gy) |
Cyclophosphamide metabolite: acrolein |
Busulfan |
Melphalan |
Concomitant use of sirolimus during conditioning |
- Citation: Tuncer HH, Rana N, Milani C, Darko A, Al-Homsi SA. Gastrointestinal and hepatic complications of hematopoietic stem cell transplantation. World J Gastroenterol 2012; 18(16): 1851-1860
- URL: https://www.wjgnet.com/1007-9327/full/v18/i16/1851.htm
- DOI: https://dx.doi.org/10.3748/wjg.v18.i16.1851