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Background: the gastrointestinal (GI) tract is the major target site of the graft-versus-host disease (GVHD). Diagnosis is based on endoscopic and histological findings., Material and Methods: we performed a retrospective study from January 1st, 1990 to December 31st, 2008 on 338 upper gastrointestinal endoscopies (gastroscopies) performed to 197 patients that underwent an allogeneic transplant with clinical suspicion of GI-GVHD., Results: endoscopic findings to the diagnosis of GVHD have a sensitivity (S) of 34%, specificity levels (SP) of 65%, a positive predictive value (PPV) of 73% and a negative predictive value (NPV) of 48%. The histological study of the endoscopic biopsies has a global sensibility of 85.6% SP = 34.6% PPV = 64.2% and NPV = 63.7%. Histological grade was correlated with the clinical grade of acute GVHD (p = 0.018)., Conclusion: upper gastrointestinal endoscopy is useful for the diagnosis of GVHD, as it allows biopsies that can ultimately lead to the diagnosis, but with limited accuracy because the histological findings have low sensitivity and specificity, while the endoscopic findings are generally nonspecific.

The identification and quantification of the monoclonal immunoglobulin in Plasma Cell Disorders (PCD) is based on electrophoresis, immunofixation (IFE) and on immunoglobulins nephelometric measurement. Even though the combination of these techniques is highly sensitive, there are two entities which pose a diagnostic challenge: Non-secretory Multiple Myeloma (MM) and Amyloidosis (AL) patients. Furthermore, when it comes to the results, these techniques have a degree of subjective interpretation and the IFE does not provide quantitative results. Within these limitations a new assay capable of quantifying free light chains (FLC) in serum has been developed. This is a great improvement in PCD and its major indication is the diagnosis and monitoring of patients with AL and non-secretory MM. In addition, its use has been recommended in the screening of all gammopathies; in the prognostic evaluation of MM and other PCD; and the definition of the stringent complete response for patients who achieve a complete remission (CR) with negative IFE and a normalized FLC ratio., (Copyright © 2010 Elsevier España, S.L. All rights reserved.)