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Impact of cytomegalovirus gastrointestinal disease on the clinical outcomes in patients with gastrointestinal graft-versus-host disease in the era of preemptive therapy.
- Source :
-
Annals of Hematology . Apr2013, Vol. 92 Issue 4, p497-504. 8p. 2 Diagrams, 4 Charts. - Publication Year :
- 2013
-
Abstract
- Cytomegalovirus gastrointestinal (CMV-GI) disease in GI graft-versus-host disease (GI-GVHD) has not been properly evaluated in the era of preemptive therapy for CMV infection. We investigated 103 patients with GI-GVHD who underwent endoscopic biopsies with immunohistochemical staining for CMV. All recipients and/or donors were seropositive for CMV and monitored with a strategy of preemptive therapy based on real-time quantitative polymerase chain reaction. Twenty-six patients (25 %) developed CMV-GI disease, especially in HLA-mismatched transplants ( P = 0.023) and with initial gut involvement of GVHD ( P = 0.009). The CMV-GI diseases were diagnosed at follow-up endoscopies ( n = 10, 39 %), comprising 19 % of 52 patients who underwent follow-up endoscopies, as well as initial endoscopies ( n = 16, 61 %), comprising 16 % of all GI-GVHD patients. In seven cases, either at initial ( n = 5) or follow-up endoscopies ( n = 2), CMV-GI disease was diagnosed in the absence of histopathologic evidence for GI-GVHD. Notably, only 11 patients (42 %) had prior CMV DNAemia before the diagnosis of CMV-GI disease, while 12 (46 %) and three (12 %) had concurrent and no CMV DNAemia, respectively. Sixty-five percent of CMV-GI disease was resolved by additional antiviral therapies, but CMV-GI disease ( P = 0.032) as well as severity of GVHD ( P = 0.001) negatively affected GVHD-specific survival. In conclusion, our data demonstrate that CMV-GI disease was a cause of initial or persistent GI manifestations after the initiation of therapy in a considerable proportion of GI-GVHD. These suggest the necessity of novel strategies to reduce CMV-GI disease as well as an effort to confirm CMV with repeated endoscopies. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 09395555
- Volume :
- 92
- Issue :
- 4
- Database :
- Academic Search Index
- Journal :
- Annals of Hematology
- Publication Type :
- Academic Journal
- Accession number :
- 85923220
- Full Text :
- https://doi.org/10.1007/s00277-012-1632-x