The following article features coverage from the American Society of Clinical Oncology 2020 meeting. Click here to read more of Hematology Advisor’s conference coverage.

Patients who develop Clostridioides difficile infection (CDI) around the time of undergoing allogenic stem cell transplantation (SCT) may be at an increased risk for hyperacute graft vs host disease (GVHD), according to research presented during the ASCO20 Virtual Scientific Program.

Hyperacute GVHD after SCT is linked to worse clinical outcomes. While several factors have been identified that help to predict GVHD incidence, the role of the microbiome has not yet been established.

CDI, a known cause of infectious diarrhea among immunocompromised patients who have not yet undergone engraftment, may affect the microbiome make-up, which can in turn have consequences for GVHD risk. A team of researchers evaluated data from 6210 adult patients hospitalized in 2014 and who underwent SCT to determine any links between CDI and GVHD incidence. All data were obtained from the the National Inpatient Sample and all included patients were at least 18 years old.

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Among all included patients, 5465 (88%) were CDI-negative and 745 (12%) were CDI-positive. The majority (62.7% in the CDI-negative group and 55.4% in the CDI-positive group) of patients were aged 50 years or older; 43.9% and 45.3% of patients in the 2 groups, respectively, were women; and most (61.8% and 66.2%, respectively) were privately insured.

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Patients with CDI were more likely to show evidence of GVHD during hospitalization than those without CDI (25.7% vs 14.2%, respectively; odds ratio, 2.1; P <.001). Evidence of GVHD did not appear to affect length or cost of hospital stay, or same-hospitalization mortality.

“Allogeneic SCT patients with CDI develop GVHD on the same hospitalization at significantly higher rates than patients without CDI,” the authors wrote. “This is true after controlling for age, sex, race, insurance, comorbidities, graft source, hospital location, and type of institution.”


Murray DCD, Kumar R, Bhandari S, Hegazi MM, et al. Incidence of graft versus host disease in peri transplant hospitalization after clostridium difficile infection. Presented at: ASCO20 Virtual Scientific Program. J Clin Oncol. 2020;38(suppl): abstr 7542.