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Clostridium Difficile infections in patients with AML or MDS undergoing allogeneic hematopoietic stem cell

Simon Amberge¹, Michael Kramer², Percy Schröttner³

¹Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden University of Technology Dresden, Dresden, Germany. simon.amberge@uniklinikum-dresden.de.

Bone Marrow Transplantation

|September 20, 2019

Insights

Clostridium difficile (CD) infection is common in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHCT). CD infection significantly lowers overall survival and impacts graft-versus-host disease development in these high-risk patients.

Area of Science:

Hematology
Infectious Diseases
Transplantation Immunology

Background:

Clostridium difficile (CD) infection is a leading cause of nosocomial enterocolitis.
Patients undergoing allogeneic hematopoietic stem cell transplantation (alloHCT) face a high risk of CD infection, yet large-scale studies are limited.
Previous research on CD infection in alloHCT recipients has yielded conflicting results.

Purpose of the Study:

To investigate the prevalence of Clostridium difficile infection in patients undergoing alloHCT.
To analyze the impact of CD infection on overall survival and graft-versus-host disease (GVHD) in this patient population.

Main Methods:

Retrospective analysis of 727 patients with AML or MDS undergoing alloHCT between 2004 and 2015.
Screening for CD infection at admission and weekly during aplasia.
Comparison of outcomes between CD-infected, asymptomatic CD carriers, and CD-negative patients.

Main Results:

A high prevalence of CD infection (13%) and asymptomatic carriage (14%) was observed in alloHCT recipients.
Patients with CD infection had significantly shorter overall survival (8 months vs. 25 months).
CD infection was associated with a reduced risk of acute GVHD but not gastrointestinal GVHD; symptomatic patients had higher rates of gastrointestinal GVHD.

Conclusions:

Clostridium difficile infection is highly prevalent in patients undergoing alloHCT.
CD infection is linked to significantly poorer overall survival in alloHCT recipients.
The relationship between CD infection and GVHD requires further investigation, particularly regarding symptomatic versus asymptomatic cases.

Read full analysis

Abstract:

Clostridium difficile (CD) infection is the main cause of nosocomial enterocolitis in western countries and in patients undergoing allogeneic hematopoietic stem cell transplantation (alloHCT). Recipients of alloHCT are at high risk for CD infection but large studies in this population are rare and conflicting results have been reported. We analyzed 727 patients with AML or MDS undergoing alloHCT in our center from 2004 to 2015. Ninety-six patients (13%) had CD infection and 103 patients (14%) were identified as asymptomatic carriers by screening at admission and once a week during aplasia. Patients with CD infection had a shorter median overall survival of 8 months (95% CI, 6-36 months) compared with 25 months (95% CI, 17-35 months) for patients without CD infection, (HR 1.4, p = 0.04). CD positive patients were less likely to develop acute graft-versus-host disease (aGvHD; HR 0.6, p = 0.004) compared with CD-negative patients, but did not show differences in gastrointestinal aGvHD (HR 0.9, p = 0.5). Symptomatic patients developed gastrointestinal aGvHD (HR 2.5, p = 0.02) more often compared with asymptomatic CD positive patients. This analysis demonstrates a high prevalence for CD infection in patients undergoing alloHCT. A significant lower overall survival for patients with CD infection could be demonstrated.

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