Late gastroenterological complications in children after allogeneic hematopoietic stem cell transplantation: A retrospective cohort study and a case series of children treated with Kampo medicines

Abstract

This study aimed to describe children developing late gastrointestinal (GI) complications after allogeneic hematopoietic stem cell transplantation (allo‐HSCT), focusing on Kampo medicine.At the Nagoya University Hospital Department of Pediatrics, 179 consecutive patients underwent allo‐HSCT over five years, of whom 167 achieved engraftment and survived at least 100 days post transplant and therefore were included in the study.Thirteen patients (7.8%) developed late GI symptoms. Among these, three had upper GI symptoms, three had lower GI symptoms, while seven had upper/lower GI symptoms. Total parenteral nutrition was administered in 10 (77%) patients for a median of 81 days (range: 20–303). Four (31%) had histologically proven graft‐versus‐host‐disease (GVHD), two (15%) had adverse drug reactions, and one (8%) had a viral infection. All three patients with lower GI symptoms responded to Kampo formulas' warming interior [TM1]. Two patients with upper GI symptoms had epigastric rigidity and responded to Aurantii Fructus Immaturus‐based formulas. One patient developed severe cachexia, which was successfully reversed with Kampo medicines. There were no adverse effects due to Kampo medicines.Late GI complications may be a burden on children after allo‐HSCT. Kampo medicines may provide a safe and promising therapy to resolve GI symptoms not otherwise specified.