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Clostridium Difficile infections in patients with AML or MDS undergoing allogeneic hematopoietic stem cell transplantation identify high risk for adverse outcome

Bone Marrow Transplantation volume 55, pages 367–375 (2020)Cite this article

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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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Acknowledgements

We thank Catrin Theuser for assistance with data management. The dedicated commitment of all nurses, data managers, and physicians who contributed to this analysis is highly appreciated.

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Authors and Affiliations

  1. Department of Internal Medicine I, University Hospital Carl Gustav Carus, Dresden University of Technology Dresden, Dresden, Germany

    Simon Amberge, Michael Kramer, Katharina Heidrich, Renate Schmelz, Jan M. Middeke, Jochen Hampe, Johannes Schetelig, Martin Bornhäuser & Friedrich Stölzel

  2. Institute of Medical Microbiology and Hygiene, Medical Faculty Carl Gustav Carus, Dresden University of Technology, Dresden, Germany

    Percy Schröttner & Florian Gunzer

  3. DKMS Clinical Trials Unit, Dresden, Germany

    Johannes Schetelig & Friedrich Stölzel

  4. National Center for Tumor Diseases, Dresden, Germany

    Martin Bornhäuser

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  1. Simon Amberge
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Correspondence to Simon Amberge.

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Conflict of interest

This study was supported by an investigator sponsored research (ISR) grant from Astellas. Astellas has had no role in the study design, data collection or analysis, and paper preparation and submission. The authors declare that they have no conflict of interest.

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Amberge, S., Kramer, M., Schröttner, P. et al. Clostridium Difficile infections in patients with AML or MDS undergoing allogeneic hematopoietic stem cell transplantation identify high risk for adverse outcome. Bone Marrow Transplant 55, 367–375 (2020). https://doi.org/10.1038/s41409-019-0678-y

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