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Persistent Gastrointestinal GVHD: The Application and Utility of Histologic Grading Schemes

  • Howard M. ShulmanEmail author
  • David W. Woolston
  • David Myerson
Chapter

Abstract

Prolonged GVHD is a major cause of morbidity and mortality. The damages are not uniform for different regions of the gut. Previous grading methods using the Lerner-Sale scheme have not been useful at predicting outcome at early stages. However, more recent studies indicate involvement of the lower gut, with Lerner-Sale grade I portending a worse outcome. The Myerson apoptotic activitiy index, a second grading scheme which quantitiates the range of apoptotic bodies within Lerner-Sale grade I, provides useful information for guiding therapeutic intervention. The spectrum of gut GVHD, from a single apoptosis to diffuse intestinal ulceration, is presented along with the therapeutic implications.

Keywords

Prolonged gut GVHD Grading of gut GVHD Lerner-Sale gut GVHD grading Myerson gut GVHD activity score Gut GVHD histology and prognosis 

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Howard M. Shulman
    • 1
    • 2
    • 3
    Email author
  • David W. Woolston
    • 1
  • David Myerson
    • 1
    • 2
    • 3
  1. 1.Clinical Research DivisionFred Hutchinson Cancer Research CenterSeattleUSA
  2. 2.Department of PathologyUniversity of Washington School of MedicineSeattleUSA
  3. 3.Pathology SectionSeattle Cancer Care AllianceSeattleUSA

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