Incidence, Risk Factors and Outcome Of Cytomegalovirus (CMV) Viremia and CMV Gastroenteritis In Patients With Gastrointestinal Graft Versus Host Disease (GI GVHD)

• Type of Material: Article
• Authors: Divaya Bhutani, Wayne State University; Gregory Dyson, Wayne State University; Richard Manasa, Wayne State University; Abhinvav Deol, Wayne State University; Voravit Ratanatharathorn, Wayne State University; Lois Ayash, Wayne State University; Muneer Abidi, Wayne State University; Lawrence G. Lum, Wayne State University; Zaid Al-Kadhimi, Emory University; Joseph P. Uberti, Wayne State University
• Language: English
• Date: 2013-11-15
• Publisher: American Society of Hematology
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 American Society for Blood and Marrow Transplantation.
• Final Published Version (URL): http://dx.doi.org/10.1182/blood.V122.21.2039.2039
• Title of Journal or Parent Work: Blood
• ISSN: 0006-4971
• Volume: 122
• Issue: 21
• Start Page: 159
• End Page: 164
• Keywords: Hematology; Life Sciences & Biomedicine; Science & Technology
• Research Categories: Health Sciences, Medicine and Surgery

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.