Viral enteritis after allogeneic hematopoietic stem cell transplantation: pathogens, clinical characteristics, and outcomes

Abstract

Viral enteritis is a frequent complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT). However, data on this condition are limited, and the most frequent enteric pathogens, clinical characteristics, and patient outcomes remain unknown. To better characterize post-HSCT viral enteritis, we retrospectively analyzed 59 patients who underwent allo-HSCT and received a diagnosis of viral enteritis confirmed by intestinal biopsy specimens. Cytomegalovirus (CMV) (37.3%), human herpesvirus 6 (HHV-6) (37.3%), and Epstein-Barr virus (EBV) (33.9%) were the most frequently identified pathogens. The median time for diagnosis was 56 days post-allo-HSCT. Diarrhea and abdominal pain were the most common symptoms. Notably, 35 patients experienced diarrhea lasting 14 days or more, with a median duration of 16 days (range: 3–57 days). Endoscopic findings revealed concurrent graft-versus-host disease (GVHD) in 45 patients. The overall survival rates for patients with viral enteritis at 1 and 3 years were 58.6% and 55.3%, respectively. Importantly, patients with CMV enteritis had significantly poorer overall survival compared to those with other viral enteritis types(P = 0.035). In summary, viral enteritis is a significant complication post-allo-HSCT, with CMV, HHV-6, and EBV being the most common pathogens. Early identification and management are crucial, especially for CMV enteritis which is associated with poorer outcomes.