A preemptive strategy has successfully decreased cytomegalovirus (CMV) disease after allogeneic hematopoietic cell transplantation (HCT).However, some recipients still develop CMV gastroenteritis, especially after acute graft-versus-host disease (aGVHD), and its incidence, risk factors, and prognostic impact remain to be elucidated.We retrospectively analyzed 3759 consecutive adult patientswho developed grade II-IV aGVHD using a Japanese registry database. The cumulative incidence of CMV gastroenteritiswas 5.7%by day 365 fromthe development of grade II-IV aGVHD. Advanced age (hazard ratio [HR], 1.60; 95%confidence interval [CI], 1.16-2.22; P=.004), GVHDprophylaxiswithmycophenolate mofetil and calcineurin inhibitor (HR, 1.73; 95%CI, 1.08-2.77; P=.024), lower-gut aGVHD (HR, 2.17; 95%CI, 1.58-2.98; P<.001), and the use of systemic steroids (HR, 1.78; 95%CI, 1.16-2.74; P5.008)were independent risk factors for CMV gastroenteritis. Development of CMV gastroenteritis was associated with an increased risk of nonrelapsemortality (HR, 1.89; 95%CI, 1.50-2.39; P<.001). Moreover, letermovir prophylaxis significantly reduced both the incidence of CMV gastroenteritis (HR, 0.50; 95%CI, 0.25-0.99; P=.047) and the risk of nonrelapsemortality (HR, 0.72; 95%CI, 0.52- 0.99; P=.043). In summary, CMV gastroenteritis is a life-threatening complication that sets the need for preventive strategieswith letermovir and targeted surveillance.
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