Cytomegalovirus gastroenteritis in patients with acute graft-versushost disease

Yu Akahoshi, Shun Ichi Kimura, Yuma Tada, Toshihiro Matsukawa, Masaharu Tamaki, Noriko Doki, Naoyuki Uchida, Masatsugu Tanaka, Hirohisa Nakamae, Takuro Kuriyama, Ken Ichi Matsuoka, Takashi Ikeda, Takafumi Kimura, Takahiro Fukuda, Yoshinobu Kanda, Yoshiko Atsuta, Makoto Murata, Seitaro Terakura, Hideki Nakasone

Research output: Contribution to journalArticlepeer-review

6 Scopus citations


A preemptive strategy has successfully decreased cytomegalovirus (CMV) disease after allogeneic hematopoietic cell transplantation (HCT).However, some recipients still develop CMV gastroenteritis, especially after acute graft-versus-host disease (aGVHD), and its incidence, risk factors, and prognostic impact remain to be elucidated.We retrospectively analyzed 3759 consecutive adult patientswho developed grade II-IV aGVHD using a Japanese registry database. The cumulative incidence of CMV gastroenteritiswas 5.7%by day 365 fromthe development of grade II-IV aGVHD. Advanced age (hazard ratio [HR], 1.60; 95%confidence interval [CI], 1.16-2.22; P=.004), GVHDprophylaxiswithmycophenolate mofetil and calcineurin inhibitor (HR, 1.73; 95%CI, 1.08-2.77; P=.024), lower-gut aGVHD (HR, 2.17; 95%CI, 1.58-2.98; P<.001), and the use of systemic steroids (HR, 1.78; 95%CI, 1.16-2.74; P5.008)were independent risk factors for CMV gastroenteritis. Development of CMV gastroenteritis was associated with an increased risk of nonrelapsemortality (HR, 1.89; 95%CI, 1.50-2.39; P<.001). Moreover, letermovir prophylaxis significantly reduced both the incidence of CMV gastroenteritis (HR, 0.50; 95%CI, 0.25-0.99; P=.047) and the risk of nonrelapsemortality (HR, 0.72; 95%CI, 0.52- 0.99; P=.043). In summary, CMV gastroenteritis is a life-threatening complication that sets the need for preventive strategieswith letermovir and targeted surveillance.

Original languageEnglish
Pages (from-to)574-584
Number of pages11
JournalBlood advances
Issue number2
StatePublished - 25 Jan 2022
Externally publishedYes


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