Severe gastrointestinal bleeding after hematopoietic cell transplantation, 1987-1997

Incidence, causes, and outcome

Jonathan M. Schwartz, John L. Wolford, Mark D. Thornquist, David M. Hockenbery, Carol S. Murakami, Fred Drennan, Mary Hinds, Simone I. Strasser, Santiago Otero Lopez-Cubero, Harpreet S. Brar, Cynthia W. Ko, Michael D. Saunders, Charles N. Okolo, George B. McDonald

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

OBJECTIVE: Severe GI bleeding after hematopoietic cell transplantation is commonly due to lesions that are unusual in nontransplant patients. The frequency of GI bleeding appears to have decreased over the last decade, but the reasons have not been readily apparent. We sought to determine the incidence of severe bleeding during two time periods, to describe the causes and outcomes of bleeding, and to analyze the reasons behind an apparent decline in severe bleeding over the decade covered. METHODS: During 1986-1987 and 1996-1997, we followed all patients with and without severe bleeding at our institution, a marrow transplant center. RESULTS: Over this decade, the incidence of severe bleeding declined from 50/467 (10.7%) to 15/635 (2.4%) (p < 0.0001). Overall mortality from intestinal bleeding declined from 3.6% to 0.9% (p = 0.002), but mortality in those with bleeding remained high (34% vs 40%). The onset (day 42 vs 47) and platelet counts (35,994 vs 37,600/μl) were similar, but the sites and causes of bleeding were different. During 1986-1987, 27/50 patients bled from multiple GI sites, viral and fungal ulcers, or graft-versus-host disease (GVHD). Over the decade, bleeding from GVHD had decreased 80% (p < 0.0001), and bleeding from viral (p < 0.0001) and fungal (p = 0.023) ulcers almost disappeared. CONCLUSIONS: The incidence of severe GI bleeding has declined significantly over the last decade because of prevention of viral and fungal infections and severe acute GVHD. However, severe bleeding after transplant remains a highly morbid event, particularly among patients with GVHD.

Original languageEnglish (US)
Pages (from-to)385-393
Number of pages9
JournalAmerican Journal of Gastroenterology
Volume96
Issue number2
DOIs
StatePublished - 2001
Externally publishedYes

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Cell Transplantation
Hemorrhage
Incidence
Graft vs Host Disease
Ulcer
Transplants
Mortality
Mycoses
Virus Diseases
Platelet Count

ASJC Scopus subject areas

  • Gastroenterology

Cite this

Severe gastrointestinal bleeding after hematopoietic cell transplantation, 1987-1997 : Incidence, causes, and outcome. / Schwartz, Jonathan M.; Wolford, John L.; Thornquist, Mark D.; Hockenbery, David M.; Murakami, Carol S.; Drennan, Fred; Hinds, Mary; Strasser, Simone I.; Lopez-Cubero, Santiago Otero; Brar, Harpreet S.; Ko, Cynthia W.; Saunders, Michael D.; Okolo, Charles N.; McDonald, George B.

In: American Journal of Gastroenterology, Vol. 96, No. 2, 2001, p. 385-393.

Research output: Contribution to journalArticle

Schwartz, JM, Wolford, JL, Thornquist, MD, Hockenbery, DM, Murakami, CS, Drennan, F, Hinds, M, Strasser, SI, Lopez-Cubero, SO, Brar, HS, Ko, CW, Saunders, MD, Okolo, CN & McDonald, GB 2001, 'Severe gastrointestinal bleeding after hematopoietic cell transplantation, 1987-1997: Incidence, causes, and outcome', American Journal of Gastroenterology, vol. 96, no. 2, pp. 385-393. https://doi.org/10.1016/S0002-9270(00)02342-X
Schwartz, Jonathan M. ; Wolford, John L. ; Thornquist, Mark D. ; Hockenbery, David M. ; Murakami, Carol S. ; Drennan, Fred ; Hinds, Mary ; Strasser, Simone I. ; Lopez-Cubero, Santiago Otero ; Brar, Harpreet S. ; Ko, Cynthia W. ; Saunders, Michael D. ; Okolo, Charles N. ; McDonald, George B. / Severe gastrointestinal bleeding after hematopoietic cell transplantation, 1987-1997 : Incidence, causes, and outcome. In: American Journal of Gastroenterology. 2001 ; Vol. 96, No. 2. pp. 385-393.
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abstract = "OBJECTIVE: Severe GI bleeding after hematopoietic cell transplantation is commonly due to lesions that are unusual in nontransplant patients. The frequency of GI bleeding appears to have decreased over the last decade, but the reasons have not been readily apparent. We sought to determine the incidence of severe bleeding during two time periods, to describe the causes and outcomes of bleeding, and to analyze the reasons behind an apparent decline in severe bleeding over the decade covered. METHODS: During 1986-1987 and 1996-1997, we followed all patients with and without severe bleeding at our institution, a marrow transplant center. RESULTS: Over this decade, the incidence of severe bleeding declined from 50/467 (10.7{\%}) to 15/635 (2.4{\%}) (p < 0.0001). Overall mortality from intestinal bleeding declined from 3.6{\%} to 0.9{\%} (p = 0.002), but mortality in those with bleeding remained high (34{\%} vs 40{\%}). The onset (day 42 vs 47) and platelet counts (35,994 vs 37,600/μl) were similar, but the sites and causes of bleeding were different. During 1986-1987, 27/50 patients bled from multiple GI sites, viral and fungal ulcers, or graft-versus-host disease (GVHD). Over the decade, bleeding from GVHD had decreased 80{\%} (p < 0.0001), and bleeding from viral (p < 0.0001) and fungal (p = 0.023) ulcers almost disappeared. CONCLUSIONS: The incidence of severe GI bleeding has declined significantly over the last decade because of prevention of viral and fungal infections and severe acute GVHD. However, severe bleeding after transplant remains a highly morbid event, particularly among patients with GVHD.",
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T1 - Severe gastrointestinal bleeding after hematopoietic cell transplantation, 1987-1997

T2 - Incidence, causes, and outcome

AU - Schwartz, Jonathan M.

AU - Wolford, John L.

AU - Thornquist, Mark D.

AU - Hockenbery, David M.

AU - Murakami, Carol S.

AU - Drennan, Fred

AU - Hinds, Mary

AU - Strasser, Simone I.

AU - Lopez-Cubero, Santiago Otero

AU - Brar, Harpreet S.

AU - Ko, Cynthia W.

AU - Saunders, Michael D.

AU - Okolo, Charles N.

AU - McDonald, George B.

PY - 2001

Y1 - 2001

N2 - OBJECTIVE: Severe GI bleeding after hematopoietic cell transplantation is commonly due to lesions that are unusual in nontransplant patients. The frequency of GI bleeding appears to have decreased over the last decade, but the reasons have not been readily apparent. We sought to determine the incidence of severe bleeding during two time periods, to describe the causes and outcomes of bleeding, and to analyze the reasons behind an apparent decline in severe bleeding over the decade covered. METHODS: During 1986-1987 and 1996-1997, we followed all patients with and without severe bleeding at our institution, a marrow transplant center. RESULTS: Over this decade, the incidence of severe bleeding declined from 50/467 (10.7%) to 15/635 (2.4%) (p < 0.0001). Overall mortality from intestinal bleeding declined from 3.6% to 0.9% (p = 0.002), but mortality in those with bleeding remained high (34% vs 40%). The onset (day 42 vs 47) and platelet counts (35,994 vs 37,600/μl) were similar, but the sites and causes of bleeding were different. During 1986-1987, 27/50 patients bled from multiple GI sites, viral and fungal ulcers, or graft-versus-host disease (GVHD). Over the decade, bleeding from GVHD had decreased 80% (p < 0.0001), and bleeding from viral (p < 0.0001) and fungal (p = 0.023) ulcers almost disappeared. CONCLUSIONS: The incidence of severe GI bleeding has declined significantly over the last decade because of prevention of viral and fungal infections and severe acute GVHD. However, severe bleeding after transplant remains a highly morbid event, particularly among patients with GVHD.

AB - OBJECTIVE: Severe GI bleeding after hematopoietic cell transplantation is commonly due to lesions that are unusual in nontransplant patients. The frequency of GI bleeding appears to have decreased over the last decade, but the reasons have not been readily apparent. We sought to determine the incidence of severe bleeding during two time periods, to describe the causes and outcomes of bleeding, and to analyze the reasons behind an apparent decline in severe bleeding over the decade covered. METHODS: During 1986-1987 and 1996-1997, we followed all patients with and without severe bleeding at our institution, a marrow transplant center. RESULTS: Over this decade, the incidence of severe bleeding declined from 50/467 (10.7%) to 15/635 (2.4%) (p < 0.0001). Overall mortality from intestinal bleeding declined from 3.6% to 0.9% (p = 0.002), but mortality in those with bleeding remained high (34% vs 40%). The onset (day 42 vs 47) and platelet counts (35,994 vs 37,600/μl) were similar, but the sites and causes of bleeding were different. During 1986-1987, 27/50 patients bled from multiple GI sites, viral and fungal ulcers, or graft-versus-host disease (GVHD). Over the decade, bleeding from GVHD had decreased 80% (p < 0.0001), and bleeding from viral (p < 0.0001) and fungal (p = 0.023) ulcers almost disappeared. CONCLUSIONS: The incidence of severe GI bleeding has declined significantly over the last decade because of prevention of viral and fungal infections and severe acute GVHD. However, severe bleeding after transplant remains a highly morbid event, particularly among patients with GVHD.

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