Divaya Bhutanifrom 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%) vs26.7% (95% CI, 19–30%), P= 0.24
- Median time to CDI development: 12.5 days (range, Day 3 to Day 113) vs16 days (range, Day 3 to Day 209)
- Incidence of GI GvHD: 33% vs23%
- Use of systemic steroids: 33% vs45%
- Median time to GvHD development: 39 days vs28 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.”