The role of clostridium difficile infection in gastrointestinal graft-versus-host disease

Divaya Bhutani from Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA, and colleagues retrospectively analyzed the relationship between clostridium difficile infection (CDI) and acute gastrointestinal graft-versus-host disease (GI GvHD) in patients undergoing allogeneic stem cell transplantation (allo-SCT). The study was published ahead of print in Bone Marrow Transplantation.

In this study, 310 consecutive patients were included and divided into two groups:

• Group 1: n = 100 patients who received related donor allo-SCT, transplanted between March 2010 and December 2013
  • Age at transplant: 54 years (range, 19–59)
  • Diagnosis: leukemia (48%), lymphoma (29%), MDS (12%), other (11%)
  • Source of stem cells: BM (9%), PBSC (91%)
• Group 2: n = 210 patients who received unrelated donor allo-SCT, transplanted between December 2009 and December 2013
  • Age at transplant: 56 years (range, 20–62)
  • Diagnosis: leukemia (57%), lymphoma (19%), MDS (14%), other (10%)
  • Source of stem cells: BM (8%), PBSC (92%)

Key findings:

Data is given as group 1 vs group 2

• Cumulative incidence of CDI: 18% (95% CI, 11–26%) vs 26.7% (95% CI, 19–30%), P = 0.24
• Median time to CDI development: 12.5 days (range, Day 3 to Day 113) vs 16 days (range, Day 3 to Day 209)
• Incidence of GI GvHD: 33% vs 23%
• Use of systemic steroids: 33% vs 45%
• Median time to GvHD development: 39 days vs 28 days
• Patients with CDI were more likely developed acute GI GvHD: HR = 1.92 (95% CI, 1.15–3.19), P = 0.01
• Acute GI GvHD significantly associated with increased mortality: HR = 1.7 (95% CI, 1.15–2.5), P = 0.01

In summary, this retrospective study found that patients who develop CDI in the post-transplant period have an increased risk of acute GI GvHD. “The highest incidence of CDI is during pre-engraftment period within the first 2 weeks after transplantation, which correlates with the duration of neutropenia and antibiotic use. In addition, CDI can complicate therapy of GI GVHD with increased incidence with use of systemic steroids.”