Endoscopic Findings Can Help Predict Cytomegalovirus Colitis after Hematopoietic Stem Cell Transplantation

Graft-versus-host disease (GVHD) of the gut and cytomegalovirus (CMV) colitis are common and severe adverse events of allogeneic hematopoietic stem cell transplantation (HSCT). The diagnosis of gut-GVHD and CMV colitis using colonoscopy is crucial for deciding treatment strategies. Endoscopy could help to rapidly diagnose CMV colitis; however, endoscopic findings characteristic of CMV colitis remain unclear. Therefore, we aimed to determine whether endoscopic findings can help predict pathologically diagnosed CMV colitis.

We retrospectively analyzed the data of 271 of 340 patients who underwent biopsy during colonoscopy for colitis or diarrhea after allogeneic HSCT between May 2007 and December 2018. The pathological results of the biopsies were categorized as follows: (1) nonspecific findings, (2) CMV colitis, (3) gut-GVHD, and (4) both CMV colitis and gut-GVHD. Moreover, (2) and (4) were defined as pathologically diagnosed CMV colitis. We analyzed the association between each endoscopic finding and pathological CMV colitis using logistic regression and developed a predictive model for CMV colitis.

We identified 59 patients with pathologically diagnosed CMV colitis (21.8%). Univariate analysis showed a significant association between pathologically diagnosed CMV colitis and ulceration, erosion, erythema, and shedding mucosa in the terminal ileum and colon. Multivariate analysis revealed that ulceration and erosion were independent predictive factors for CMV colitis. The area under the curve of the model based on endoscopic findings was 0.71.

Ulceration and erosion are independent predictive factors for pathologically diagnosed CMV colitis after allogeneic HSCT. Endoscopic findings may facilitate earlier initiation of CMV colitis treatment.