Cytomegalovirus DNA load monitoring in stool specimens for anticipating the occurrence of intestinal acute graft-versus-host disease following allogeneic hematopoietic stem cell transplantation: Is it of any value?

Autores de IIS La Fe

• José Luis Piñana Sánchez

  Autor

• María Dolores Gómez Ruiz

  Autor

• Eva María González Barberá

  Autor

• Juan Bautista Montoro Gómez

  Autor

• Manuel Nuno Direito De Morais Guerreiro

  Autor

• Aitana Balaguer Roselló

  Autor

• Jaime Sanz Caballer

  Autor

Participantes ajenos a IIS La Fe

• Bueno F.
• Albert E.
• Giménez E.
• Pérez A.
• Hernández-Boluda J.C.
• Hernani R.
• Solano C.
• Navarro D.

Grupos

• Hematología y Hemoterapia

• Infección Grave

Abstract

Background: Data have been published suggesting a bidirectional interaction between cytomegalovirus (CMV) infection and acute graft-versus-host disease (aGvHD) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. Here, we hypothesized that prospective CMV DNA monitoring in stool specimens may be useful for predicting subsequent occurrence of intestinal aGvHD (IaGvHD). Methods: This two-center study enrolled 121 consecutive adult patients undergoing any modality of allo-HSCT. A total of 1,009 stool specimens were collected (a median of 7 specimens/patient; range, 1-18). CMV DNA monitoring in stools and plasma was performed using real-time PCR assays. Results: CMV DNA was detected in stools in 20 patients (cumulative incidence, 16.9%; 95% CI, 6.3%-31.8%). Median CMV DNA level in stool specimens was 1,258 IU/0.1g (range, 210-4,087 IU/0.1 g). All these patients and their donors were CMV seropositive, and 16 of the 20 patients also had CMV DNAemia, while 4 patients had CMV DNA detected in stools without CMV DNAemia. No correlation was found between CMV DNA loads in plasma and stools (P =.40). Prior CMV DNAemia, aGvHD, or IaGvHD were not associated with presence of CMV DNA in feces. IaGvHD was present in 30 patients, in 5 of whom CMV DNA was detected in stools. Neither detection of CMV DNA in feces nor in plasma was associated with subsequent IaGvHD (OR, 0.67; 95% CI, 0.18-2.52; P =.55 and OR, 0.86; 95% CI, 0.38-1.96; P =.71, respectively). No patient in this cohort had CMV end-organ disease within the study period. Conclusion: Our study failed to provide evidence pointing to a reciprocal interaction between GI CMV infection and IaGvHD. CMV DNA monitoring in stools seems of no value to anticipate occurrence of IaGvHD. © 2020 Wiley Periodicals LLC

Keywords

• Adult; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Feces; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Humans; Intestinal Diseases; Prospective Studies; Viral Load; cyclophosphamide; cyclosporine; foscarnet; ganciclovir; mammalian target of rapamycin inhibitor; tacrolimus; thymocyte antibody; valganciclovir; virus DNA; virus DNA; acute graft versus host disease; acute lymphoblastic leukemia; acute myeloid leukemia; adult; allogeneic hematopoietic stem cell transplantation; Article; chronic leukemia; cohort analysis; controlled study; Cytomegalovirus; cytomegalovirus infection; feces; female; histopathology; human; human tissue; intestine biopsy; lymphoma; major clinical study; male; mucosa inflammation; multicenter study; multiple myeloma; myelodysplastic syndrome; observational study; priority journal; prospective study; risk factor; young adult; adverse event; complication; Cytomegalovirus; cytomegalovirus infection; enteropathy; genetics; graft versus