長期にわたり頻回の内視鏡的バルーン拡張術を要した食道慢性GVHDの1例

Chronic Esophageal Graft-versus-host Disease Requiring Frequent Endoscopic Balloon Dilation over an Extended Period, Report of a Case

要旨●患者は60歳代，男性．多発性骨髄腫に対し同種末梢血幹細胞移植が行われた．移植後90日ころより四肢，口腔に扁平苔癬様変化が生じ，皮膚・口腔慢性GVHDと診断した．同時期に嚥下時違和感も出現し，食道に発赤と粘膜上皮剝離を認めた．CyA，PSLを継続していたが，移植後7年目に食道入口部狭窄を認め，食道慢性GVHDと診断した．嚥下困難感のため定期的な内視鏡的バルーン拡張術が必要とされたが，食道潰瘍の改善をはかり免疫抑制治療を強化したところ，潰瘍は瘢痕化し嚥下困難感も軽快した．本例では6年にわたり計40回のバルーン拡張術が行われた．食道慢性GVHDはQOLを著しく低下させる可能性があり，定期的な内視鏡検査と早期の対応が望まれる．

　A 60-year-old man received allo-HSCT（allogeneic hematopoietic stem cell transplantation）for multiple myeloma. Approximately 90 days after the transplant, lichenoid lesions appeared on his extremities and oral mucosa, and he was diagnosed as having chronic dermal and oral GVHD（graft-versus-host disease）. The patient also complained of discomfort with swallowing, and mucosal redness and peeling of the esophageal epithelium were detected via upper gastrointestinal endoscopy. Esophageal entrance stenosis was observed 7 years after allo-HSCT, despite continued treatment with cyclosporine A and prednisolone for GVHD, resulting in a diagnosis of chronic esophageal GVHD. The patient subsequently underwent frequent endoscopic balloon dilation procedures for esophageal dysphagia. Scar tissue replaced the esophageal ulcer, and dysphagia was resolved by increasing immune suppressive therapy. He received balloon dilation a total of 40 times over 6 years. As chronic esophageal GVHD may significantly decrease patient's quality of life, periodic endoscopy and early treatment are advised.