Characterization of Esophageal Biopsies from Stem Cell Transplant Patients With and Without Esophageal Graft-Versus-Host Disease

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.