INCIDENCE OF LOCAL CMV INFECTION AND ACUTE INTESTINAL GVHD IN MARROW TRANSPLANT RECIPIENTS WITH SEVERE DIARRHEA

Intestinal biopsy samples derived from 22 consecutive patients with se vere diarrhoea (>1.5 l/day for 3 or more consecutive days) following a llogeneic BMT were analysed for the local presence of cytomegalovirus (CMV) and histological and immunohistological alterations described as typical for acute graft-versus-host disease (GVHD). Seventeen patient s showed extensive histopathological lesions typical for acute intesti nal GVHD grade > I, 14 marked GVHD-related immunohistological alterati ons. In intestinal biopsies from 10 of these 22 patients CMV-DNA was d etected using PCR- and in situ hybridisation techniques. In 7 of these 10 CMV-DNA positive samples CMV protein expression and in 5 cytomegal ic cells were demonstrated. CMV could predominantly be shown in biopsi es obtained from the ascending colon and/or the terminal ileum. All 10 patients with local CMV infection showed severe histopathological and immunohistological alterations described as typical for acute intesti nal GVHD. Five of seven patients with a CMV-positive intestinal biopsy showed marked improvement of lower gastrointestinal tract disease on antiviral therapy. Five of seven patients lacking local presence of CM V but with severe histopathological lesions responded to therapy with high-dose steroids. Thus, PCR screening for CMV and histopathological analysis may help to treat lower intestinal disease in the marrow tran splant recipient early and effectively.