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Relationship between clostridium difficile infection and gastrointestinal graft versus host disease in recipients of allogeneic stem cell transplantation

Bone Marrow Transplantation volume 54, pages 164–167 (2019)Cite this article

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Clostridium difficile infection (CDI) is a common infection in patients undergoing allogeneic stem cell transplantation (allo-SCT), with reported incidence ranging from 9 to 24% in the first 100 days, post transplantation [1,2,3,4]. The signs and symptoms of CDI bear resemblance to patients with acute gastrointestinal graft versus host disease (GI GVHD), making it difficult to differentiate between these two common complications of allo-SCT [5]. It has also been reported that the development of either CDI or GI GVHD can increase the risk of subsequent development of the other in the post-transplant period [1]. We examined the relationship between CDI and GI GVHD in the related and unrelated allo-SCT.

At our center, combination of tacrolimus, mycophenolate mofetil plus ATG (TM-thymo) at a total dose of 4.5 mg/kg as GVHD prophylaxis (IV infusion over 3 days: day −3, 0.5 mg/kg; day −2, 1.5 mg/kg; and day −1, 2.5 mg/kg) is used for all unrelated donor transplants since 2012; we previously reported excellent outcomes with relatively low rate of grade III–IV acute GVHD [6, 7]. For the matched related donor transplants and matched unrelated donor transplants done prior to 2012 we used a combination of tacrolimus and mycophenolate mofetil for GVHD prophylaxis. Mechanism of action of ATG in GVHD prevention is mediated through in vivo depletion of T cells, thus activation and expansion of effector cells are effectively attenuated [8]. The consequence of this action also can subject patients to increased risk of infections [7].

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References

  1. Alonso CD, Treadway SB, Hanna DB, Huff CA, Neofytos D, Carroll KC, et al. Epidemiology and outcomes of Clostridium difficile infections in hematopoietic stem cell transplant recipients. Clin Infect Dis. 2012;54:1053–63.

    Article  Google Scholar 

  2. Chopra T, Chandrasekar P, Salimnia H, Heilbrun LK, Smith D, Alangaden GJ. Recent epidemiology of Clostridium difficile infection during hematopoietic stem cell transplantation. Clin Transplant. 2011;25:E82–7.

    Article  Google Scholar 

  3. Hosokawa K, Takami A, Tsuji M, Araoka H, Ishiwata K, Takagi S, et al. Relative incidences and outcomes of Clostridium difficile infection following transplantation of unrelated cord blood, unrelated bone marrow, and related peripheral blood in adult patients: a single institute study. Transpl Infect Dis. 2014;16:412–20.

    Article  CAS  Google Scholar 

  4. Zacharioudakis IM, Ziakas PD, Mylonakis E. Clostridium difficile infection in the hematopoietic unit: a meta-analysis of published studies. Biol Blood Marrow Transplant. 2014;20:1650–4.

    Article  Google Scholar 

  5. Couriel D, Caldera H, Champlin R, Komanduri K. Acute graft-versus-host disease: pathophysiology, clinical manifestations, and management. Cancer. 2004;101:1936–46.

    Article  Google Scholar 

  6. Ratanatharathorn V, Deol A, Ayash L, Cronin S, Bhutani D, Lum LG, et al. Low-dose antithymocyte globulin enhanced the efficacy of tacrolimus and mycophenolate for GVHD prophylaxis in recipients of unrelated SCT. Bone Marrow Transplant. 2015;50:106–12.

    Article  CAS  Google Scholar 

  7. Bacigalupo A, Lamparelli T, Bruzzi P, Guidi S, Alessandrino PE, di Bartolomeo P, et al. Antithymocyte globulin for graft-versus-host disease prophylaxis in transplants from unrelated donors: 2 randomized studies from Gruppo Italiano Trapianti Midollo Osseo (GITMO). Blood. 2001;98:2942–7.

    Article  CAS  Google Scholar 

  8. Mohty M. Mechanisms of action of antithymocyte globulin: T-cell depletion and beyond. Leukemia. 2007;21:1387–94.

    Article  CAS  Google Scholar 

  9. Antharam VC, Li EC, Ishmael A, et al. Intestinal dysbiosis and depletion of butyrogenic bacteria in Clostridium difficile infection and nosocomial diarrhea. J Clin Microbiol. 2013;51:2884–92.

    Article  Google Scholar 

  10. Staffas A, Burgos da Silva M, van den Brink MR. The intestinal microbiota in allogeneic hematopoietic cell transplant and graft-versus-host disease. Blood. 2017;129:927–33.

    Article  CAS  Google Scholar 

  11. Jain T, Croswell C, Urday-Cornejo V, Awali R, Cutright J, Salimnia H, et al. Clostridium difficile colonization in hematopoietic stem cell transplant recipients: a prospective study of the epidemiology and outcomes involving toxigenic and nontoxigenic strains. Biol Blood Marrow Transplant. 2016;22:157–63.

    Article  Google Scholar 

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Authors and Affiliations

  1. Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA

    Divaya Bhutani

  2. Department of Internal medicine, Wayne State University, Detroit, MI, USA

    Charles Jaiyeoba & Paul Naylor

  3. Karmanos Cancer Institute, Wayne State University, Detroit, MI, USA

    Seongho Kim, Joseph P. Uberti, Voravit Ratanatharathorn, Lois Ayash, Abhinav Deol, Asif Alavi, Sanjay Revankar & Pranatharthi Chandrasekar

  4. Division of Infectious Diseases, Department of Internal medicine, Wayne State University, Detroit, MI, USA

    Sanjay Revankar & Pranatharthi Chandrasekar

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  1. Divaya Bhutani
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Correspondence to Divaya Bhutani.

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Bhutani, D., Jaiyeoba, C., Kim, S. et al. Relationship between clostridium difficile infection and gastrointestinal graft versus host disease in recipients of allogeneic stem cell transplantation. Bone Marrow Transplant 54, 164–167 (2019). https://doi.org/10.1038/s41409-018-0270-x

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