Tohoku J. Exp. Med., 2020 June, 251(2)

Successful Anti-TNF-Alpha Therapy for Crohn's Disease After Allogeneic Stem Cell Transplantation: A Case Report

KAZUHARU KAMACHI,¹ TOSHIHIKO ANDO,¹ NANAE TSURUOKA,² MARIKO HASHIGUCHI,³ KEISUKE KIDOGUCHI,¹ KANA KUSABA,¹ HARUNA SANO,¹ HARUHIKO SANO,¹ KYOSUKE YAMAGUCHI,¹ ATSUJIRO NISHIOKA,¹ MARIKO YOSHIMURA,¹ MASAKO YOKOO,¹ YASUSHI KUBOTA,^1,4 KENSUKE KOJIMA^1,5 and SHINYA KIMURA¹

¹Department of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Saga, Japan
²Department of Gastrointestinal Endoscopy, Department of Internal Medicine, Faculty of Medicine, Saga University, Saga, Saga, Japan
³Department of Pathology and Microbiology, Faculty of Medicine, Saga University, Saga, Saga, Japan
⁴Department of Transfusion Medicine, Saga University Hospital, Saga, Saga, Japan
⁵Department of Hematology, Kochi Medical School, Kochi University, Nankoku, Kochi, Japan

Graft-versus-host disease (GVHD) is a potentially life-threatening complication of allogeneic stem cell transplantation (Allo-SCT). Chronic GVHD, which typically presents more than 100 days after Allo-SCT, can resemble manifestations of autoimmune disease; however, there are only a few reports on the development of Crohn's disease (CD) after Allo-SCT. Here, we report a case of steroid-refractory CD after umbilical cord blood transplantation (CBT), which was dramatically improved with administration of anti-tumor necrosis factor-alpha (anti-TNF-alpha) antibodies. A 21-year-old woman with refractory Hodgkin lymphoma underwent CBT and achieved complete remission. About 1 year after CBT, she complained of intermittent abdominal pain and bloody diarrhea, and colonoscopy revealed multiple longitudinal colonic ulcers with a cobblestone appearance; thus, based on the colonoscopy findings, she was diagnosed with CD. We considered a CD-like manifestation of gastrointestinal GVHD and initially administered steroids, but the therapeutic effect was poor. Then, we administered anti-TNF-alpha antibodies, infliximab, and then adalimumab, which resulted in rapid improvement of abdominal symptoms, with no recurrence despite discontinuation of this therapy. Anti-TNF-alpha antibodies are effective for CD after Allo-SCT, which can be considered as a subsequent complication of GVHD.

Keywords —— allogeneic stem cell transplantation; anti-tumor necrosis factor-alpha antibodies; autoimmune disease; Crohn's disease; graft-versus-host disease

© 2020 Tohoku University Medical Press.

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Tohoku J. Exp. Med., 2020, 251, 81-85

Correspondence: Kazuharu Kamachi, M.D., Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University, 5-1-1 Nabeshima, Saga, Saga 849-8501, Japan.

e-mail: sm2415@cc.saga-u.ac.jp