title: Viral PCR positivity in stool before allogeneic hematopoietic cell transplantation is strongly associated with acute intestinal graft-versus-host disease.
abstract: Acute graft-versus-host disease (aGVHD) can be triggered by inflammatory conditions, including infections and mucositis. We investigated the association between PCR positivity for gastrointestinal (GI) viruses in stool before hematopoietic cell transplantation (HCT) and intestinal aGVHD using Cox proportional hazard models. We included 48 consecutive HCT patients (28 with malignancies and 20 with nonmalignancies) without GI symptoms before HCT. Fifteen patients were GI virus positive: 9 adenovirus, 3 norovirus, 2 parechovirus, and 1 astrovirus. Overall survival was 58% ± 8%. The cumulative incidence of aGVHD grade 2 to 4 was 43% ± 8% (n = 18) after a median of 47 days (range, 14 to 140). In univariate analysis, GI virus PCR positivity was the only predictor for aGVHD (P = .008): within the group of GI virus PCR-positive patients, the cumulative incidence of aGVHD 2 to 4 was 70% ± 12% versus 29 ± 8% in the PCR-negative group (P = .004). In conclusion, GI virus PCR positivity before HCT predicted development of intestinal aGVHD. These results may ultimately affect monitoring, aGVHD prophylaxis, and treatment, as well as rescheduling of elective HCTs.
authors.affiliation: Department of Pediatric Immunology and Infectious Diseases, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands. Electronic address: j.vanmontfrans@umcutrecht.nl.
authors.forename: Joris
authors.initials: J
authors.lastname: van Montfrans
authors.affiliation: Department of Pediatric Immunology and Infectious Diseases, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands.
authors.forename: Laura
authors.initials: L
authors.lastname: Schulz
authors.affiliation: Department of Pediatric Oncology, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands.
authors.forename: Birgitta
authors.initials: B
authors.lastname: Versluys
authors.affiliation: Department of Pediatric Oncology, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands.
authors.forename: Arianne
authors.initials: A
authors.lastname: de Wildt
authors.affiliation: Department of Pediatric Immunology and Infectious Diseases, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands.
authors.forename: Tom
authors.initials: T
authors.lastname: Wolfs
authors.affiliation: Department of Pediatric Oncology, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands.
authors.forename: Marc
authors.initials: M
authors.lastname: Bierings
authors.affiliation: Department of Pediatric Oncology, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands.
authors.forename: Corinne
authors.initials: C
authors.lastname: Gerhardt
authors.affiliation: Department of Pediatric Immunology and Infectious Diseases, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands.
authors.forename: Caroline
authors.initials: C
authors.lastname: Lindemans
authors.affiliation: Department of Virology, University Medical Center, Utrecht, Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Wensing
authors.affiliation: Department of Pediatric Immunology and Infectious Diseases, University Medical Center/Wilhelmina Children's Hospital, Utrecht, Netherlands; U-DANCE, Section Tumor Immunology, Laboratory for Translational Immunology, UMC Utrecht, Utrecht, Netherlands.
authors.forename: Jaap Jan
authors.initials: JJ
authors.lastname: Boelens
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D002648:Child; D002675:Child, Preschool; D004267:DNA Viruses; D004279:DNA, Viral; D018572:Disease-Free Survival; D005243:Feces / Q000821:virology*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000401:mortality / Q000517:prevention & control / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D007410:Intestinal Diseases / Q000821:virology*; D008297:Male; D009369:Neoplasms / Q000401:mortality / Q000628:therapy; D016133:Polymerase Chain Reaction; D015996:Survival Rate
chemical_list: D004279:DNA, Viral
keywords: Graft-versus-host disease (GVHD); Hematopoietic cell transplantation (HCT); Outcome; Virus