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Transpl Infect Dis. 2015 Aug;17(4):566-73. doi: 10.1111/tid.12403. Epub 2015 Jun 27.

Contribution of Clostridium difficile infection to the development of lower gastrointestinal adverse events during autologous stem cell transplantation.

Author information

1
Division of Infectious Diseases, University of Cincinnati, Cincinnati, Ohio, USA.
2
University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
3
Department of Biostatistics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
4
Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
5
Department of Genetics, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.
6
Pharmaceutical Sciences, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA.

Abstract

BACKGROUND:

Lower gastrointestinal (GI) adverse events (LGAE) are common afflictions of patients undergoing stem cell transplantation (SCT). Unfortunately, the pathophysiology remains poorly characterized. Emerging data suggest a prominent role of intestinal microbiota; however, contributions of pathogenic gut microbiota such as Clostridium difficile are not well defined. We performed a genome-wide association study (GWAS) to investigate clinical and genetic factors associated with development of LGAE.

METHODS:

A total of 972 patients undergoing autologous SCT were graded for LGAE based on Common Terminology Criteria for Adverse Events (v 4.0). Germline DNA material was obtained from leukapharesis products and genotyped using Illumina(®) Whole Genome Genotyping Infinium chemistry and HumanOmni1-Quad Bead chips containing over 1.1 million single nucleotide polymorphisms (SNPs) (Illumina, San Diego, California, USA). Statistical models incorporating clinical factors, genetic factors, and a combination of clinical plus genetic factors were utilized to compare patients who developed severe LGAE (grade 2 or above) and others.

RESULTS:

Among 972 patients, 459 (47.2%) developed severe LGAE. Baseline hemoglobin and hematocrit, estimated glomerular filtration rate, β2-microglobulin, protocol type, and C. difficile infection (CDI) were associated with severe LGAE on univariate analysis, Genomic comparisons between groups did not reveal any SNPs associated with severe LGAE and neither did incorporation of genetic factors into the clinical model. In addition, 11 candidate SNPs associated with upper GI mucositis were evaluated, alongside clinical factors in a multivariate model. Only CDI was found to be associated with severe LGAE in all models.

CONCLUSION:

CDI is a prominent factor in the development of LGAE in patients undergoing autologous SCT.

KEYWORDS:

Clostridium difficile; GI adverse events; GWAS; cancer; chemotherapy; stem cell transplant

PMID:
25988273
DOI:
10.1111/tid.12403
[Indexed for MEDLINE]
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