Graft-versus-host disease (GVHD) is less common in autologous stem cell transplantation (ASCT) recipients than in allogeneic SCT recipients. However, some cases of severe GVHD, especially involving the gastrointestinal (GI) tract, have been documented. We present a patient with primary central nervous system lymphoma (PCNSL) exhibiting severe GI-GVHD after ASCT with busulfan/thiotepa conditioning. A 59-year-old woman with PCNSL in complete remission was admitted for consolidative ASCT. She developed severe diarrhea following busulfan/thiotepa conditioning, which was considered to be neutropenic enterocolitis induced by the conditioning regimen. However, her diarrhea worsened after neutrophil engraftment, and endoscopic findings and GI tract biopsies were suggestive of autologous GVHD. The diarrhea improved markedly with systemic steroid therapy, but she developed cytomegalovirus (CMV) gastroenterocolitis due to severe immunosuppression during systemic steroid therapy for GVHD. After CMV antigenemia negativity was achieved with ganciclovir, pathological examination showed persistent gastrointestinal mucosal edema and erythema with regenerative changes, which indicated a need for continuous GVHD treatment. Treatment with systemic steroids and budesonide for more than 2 months led to remission. It is important to suspect autologous GI-GVHD and consider prompt and aggressive immunosuppressive therapy in patients that manifest persistent diarrhea after engraftment following ASCT with busulfan/thiotepa conditioning.
Keywords: Autologous stem cell transplantation; Busulfan/thiotepa; Cytomegalovirus gastroenteritis; Graft versus host disease; Primary central nervous system lymphoma.