Incidence, Risk Factors, and Outcome of Cytomegalovirus Viremia and Gastroenteritis in Patients with Gastrointestinal Graft-versus-Host Disease

Divaya Bhutani, Gregory Dyson, Richard Manasa, Abhinav Deol, Voravit Ratanatharathorn, Lois Ayash, Muneer Abidi, Lawrence G. Lum, Zaid Al-Kadhimi, Joseph P. Uberti

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Abstract

Gastrointestinal (GI) graft-versus-host disease (GVHD) is one of the most common causes of morbidity and mortality after allogeneic stem cell transplantation. In addition, cytomegalovirus (CMV) infection of the gastrointestinal tract can complicate the post-transplantation course of these patients and it can be difficult to differentiate the 2 diagnoses given that they can present with similar symptoms. We retrospectively analyzed 252 patients who were diagnosed with GI GVHD to evaluate the incidence, risk factors, and outcomes of CMV viremia and CMV gastroenteritis in these patients. The median age at the time of transplantation was 51years, 35% were related donor transplantations, and 65% were unrelated donor transplantations. A total of 114 (45%) patients developed CMV viremia at a median of 34days (range, 14 to 236days) after transplantation. Only recipient CMV IgG serostatus was significantly associated with development of CMV viremia (P<.001). The incidence of CMV viremia with relation to donor (D) and recipient (R) CMV serostatus subgroups was as follows: D+/R+, 73%; D-/R+, 67%; D+/R-, 19%; and D-/R-, 0. A total of 31 patients were diagnosed with a biopsy-proven CMV gastroenteritis; 2 patients had evidence of CMV gastroenteritis and GVHD on the first biopsy and 29 on the second biopsy. Median time to development of CMV gastroenteritis was 52days (range, 19 to 236days) after transplantation. Using death as a competing risk, the cumulative incidence of CMV gastroenteritis at 1year was 16.4%. The incidence of CMV gastroenteritis in relation to the donor/recipient serostatus was as follows: D+/R+, 22%; D-/R+, 31%; D+/R-, 12%; and D-/R. -, 0. Median follow-up time for the 252 patients was 35.4 (95% CI 23.8 to 44.8) months. The estimated overall survival rate at 1 and 2years was .45 (95% confidence interval [CI], .39 to .52) and .39 (95% CI, .33 to .46), respectively. Of the examined variables, those related to the overall survival were maximal clinical GVHD grade (P < .001) and development of CMV gastroenteritis (P=008). Development of CMV viremia was not associated with increased mortality. In conclusion, CMV gastroenteritis is common complication in patients with GI GVHD and can adversely affect the prognosis.

Original languageEnglish (US)
Pages (from-to)159-164
Number of pages6
JournalBiology of Blood and Marrow Transplantation
Volume21
Issue number1
DOIs
StatePublished - Jan 1 2015

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Viremia
Gastroenteritis
Graft vs Host Disease
Cytomegalovirus
Incidence
Transplantation
Tissue Donors
Confidence Intervals
Biopsy
Unrelated Donors
Mortality
Cytomegalovirus Infections
Stem Cell Transplantation
Gastrointestinal Tract

Keywords

  • Allogeneic stem cell transplantation
  • Cytomegalovirus gastroenteritis
  • Cytomegalovirus viremia
  • Graft-versus-host disease

ASJC Scopus subject areas

  • Hematology
  • Transplantation

Cite this

Incidence, Risk Factors, and Outcome of Cytomegalovirus Viremia and Gastroenteritis in Patients with Gastrointestinal Graft-versus-Host Disease. / Bhutani, Divaya; Dyson, Gregory; Manasa, Richard; Deol, Abhinav; Ratanatharathorn, Voravit; Ayash, Lois; Abidi, Muneer; Lum, Lawrence G.; Al-Kadhimi, Zaid; Uberti, Joseph P.

In: Biology of Blood and Marrow Transplantation, Vol. 21, No. 1, 01.01.2015, p. 159-164.

Research output: Contribution to journalArticle

Bhutani, Divaya ; Dyson, Gregory ; Manasa, Richard ; Deol, Abhinav ; Ratanatharathorn, Voravit ; Ayash, Lois ; Abidi, Muneer ; Lum, Lawrence G. ; Al-Kadhimi, Zaid ; Uberti, Joseph P. / Incidence, Risk Factors, and Outcome of Cytomegalovirus Viremia and Gastroenteritis in Patients with Gastrointestinal Graft-versus-Host Disease. In: Biology of Blood and Marrow Transplantation. 2015 ; Vol. 21, No. 1. pp. 159-164.
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AU - Dyson, Gregory

AU - Manasa, Richard

AU - Deol, Abhinav

AU - Ratanatharathorn, Voravit

AU - Ayash, Lois

AU - Abidi, Muneer

AU - Lum, Lawrence G.

AU - Al-Kadhimi, Zaid

AU - Uberti, Joseph P.

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N2 - Gastrointestinal (GI) graft-versus-host disease (GVHD) is one of the most common causes of morbidity and mortality after allogeneic stem cell transplantation. In addition, cytomegalovirus (CMV) infection of the gastrointestinal tract can complicate the post-transplantation course of these patients and it can be difficult to differentiate the 2 diagnoses given that they can present with similar symptoms. We retrospectively analyzed 252 patients who were diagnosed with GI GVHD to evaluate the incidence, risk factors, and outcomes of CMV viremia and CMV gastroenteritis in these patients. The median age at the time of transplantation was 51years, 35% were related donor transplantations, and 65% were unrelated donor transplantations. A total of 114 (45%) patients developed CMV viremia at a median of 34days (range, 14 to 236days) after transplantation. Only recipient CMV IgG serostatus was significantly associated with development of CMV viremia (P<.001). The incidence of CMV viremia with relation to donor (D) and recipient (R) CMV serostatus subgroups was as follows: D+/R+, 73%; D-/R+, 67%; D+/R-, 19%; and D-/R-, 0. A total of 31 patients were diagnosed with a biopsy-proven CMV gastroenteritis; 2 patients had evidence of CMV gastroenteritis and GVHD on the first biopsy and 29 on the second biopsy. Median time to development of CMV gastroenteritis was 52days (range, 19 to 236days) after transplantation. Using death as a competing risk, the cumulative incidence of CMV gastroenteritis at 1year was 16.4%. The incidence of CMV gastroenteritis in relation to the donor/recipient serostatus was as follows: D+/R+, 22%; D-/R+, 31%; D+/R-, 12%; and D-/R. -, 0. Median follow-up time for the 252 patients was 35.4 (95% CI 23.8 to 44.8) months. The estimated overall survival rate at 1 and 2years was .45 (95% confidence interval [CI], .39 to .52) and .39 (95% CI, .33 to .46), respectively. Of the examined variables, those related to the overall survival were maximal clinical GVHD grade (P < .001) and development of CMV gastroenteritis (P=008). Development of CMV viremia was not associated with increased mortality. In conclusion, CMV gastroenteritis is common complication in patients with GI GVHD and can adversely affect the prognosis.

AB - Gastrointestinal (GI) graft-versus-host disease (GVHD) is one of the most common causes of morbidity and mortality after allogeneic stem cell transplantation. In addition, cytomegalovirus (CMV) infection of the gastrointestinal tract can complicate the post-transplantation course of these patients and it can be difficult to differentiate the 2 diagnoses given that they can present with similar symptoms. We retrospectively analyzed 252 patients who were diagnosed with GI GVHD to evaluate the incidence, risk factors, and outcomes of CMV viremia and CMV gastroenteritis in these patients. The median age at the time of transplantation was 51years, 35% were related donor transplantations, and 65% were unrelated donor transplantations. A total of 114 (45%) patients developed CMV viremia at a median of 34days (range, 14 to 236days) after transplantation. Only recipient CMV IgG serostatus was significantly associated with development of CMV viremia (P<.001). The incidence of CMV viremia with relation to donor (D) and recipient (R) CMV serostatus subgroups was as follows: D+/R+, 73%; D-/R+, 67%; D+/R-, 19%; and D-/R-, 0. A total of 31 patients were diagnosed with a biopsy-proven CMV gastroenteritis; 2 patients had evidence of CMV gastroenteritis and GVHD on the first biopsy and 29 on the second biopsy. Median time to development of CMV gastroenteritis was 52days (range, 19 to 236days) after transplantation. Using death as a competing risk, the cumulative incidence of CMV gastroenteritis at 1year was 16.4%. The incidence of CMV gastroenteritis in relation to the donor/recipient serostatus was as follows: D+/R+, 22%; D-/R+, 31%; D+/R-, 12%; and D-/R. -, 0. Median follow-up time for the 252 patients was 35.4 (95% CI 23.8 to 44.8) months. The estimated overall survival rate at 1 and 2years was .45 (95% confidence interval [CI], .39 to .52) and .39 (95% CI, .33 to .46), respectively. Of the examined variables, those related to the overall survival were maximal clinical GVHD grade (P < .001) and development of CMV gastroenteritis (P=008). Development of CMV viremia was not associated with increased mortality. In conclusion, CMV gastroenteritis is common complication in patients with GI GVHD and can adversely affect the prognosis.

KW - Allogeneic stem cell transplantation

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KW - Cytomegalovirus viremia

KW - Graft-versus-host disease

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