Endoscopic diagnosis of cytomegalovirus gastritis after allogeneic hematopoietic stem cell transplantation

Table 1 Patient characteristics with and without CMV gastritis

Variables		Patients with CMV gastritis (n = 7)	Patients without CMV gastritis (n = 108)
Median age (range)		47 (26-62)	45 (18-69)
Gender	Male/female	5/2	65/43
Underlying diseases	Acute leukemia	1	41
	Chronic leukemia	2	15
	Malignant lymphoma	3	21
	Myelodysplastic syndrome	1	22
	Others	0	9
Preparative regimens	Myeloablative/reduced-intensity	2/5	48/60
Stem cell sources	Marrow/peripheral blood/cord blood	3/3/1	39/64/5
GVHD prophylaxis	CSP alone/CSP + MTX/CSP + MMF/	2/3/0/2a/0	36/64/2/2a/4
	FK506 + MTX/FK506 Alone

CMV: Cytomegalovirus; GVHD: Graft-versus host disease; CSP: Cyclosporine; MTX: Methotrexate; MMF: Mycophenolate mofetil; FK506: Tacrolimus.

^aP = 0.018.

Table 2 Clinical features in patients with and without CMV gastritis

Variables			Patients with CMV gastritis (n = 7)	Patients without CMV gastritis (n = 108)
Gastrointestinal symptoms at EGD		Nausea	2	60
		Vomiting	1	26
		Abdominal pain	5a	31a
		Abdominal discomfort	2	23
		Hematemesis	1	2
		Tarry stool	2	6
		Watery diarrhea	4	32
		Appetite loss	0	40
CMV	Median onset of CMV gastritis	Days (range)	63 (33-167)	NA
	CMV antigenemia (C7-HRP) at EGD	Positive/negative/not done	6b/1/0	28b/71/9
		Median number of positive cells per 50 000 (range)	8d (0-143)	0d (0-167)
	Involved organs of CMV diseases	Esophagitis/duodenitis/enterocolitis/	1/2/1/0/0	0/0/4/0/0
		pneumonitis/retinitis
GVHD		Positive (clinical grade: I/II/III/IV)	7c (2/2/3/0)	65c (45/10/9/1)

EGD: Esophagogastroduodenoscopy; NA: Not applicable.

^aP = 0.030,

^bP = 0.0026,

^cP = 0.044,

^dP = 0.0023.

Table 3 Clinical features of CMV gastritis

	Demographics	Gastrointestinal symptoms			CMV antigenemia assay
	Age (yr), gender, diagnosis	Any symptoms	Abdominal pain		Onset (d)	Level at EGD (cells per 50 000)
			Onset (d)	Localization in abdomen
Case 1	34, male, CML	Abdominal pain, tarry stool	81	Upper abdomen	88	8
Case 2	43, female, MDS	Nausea, abdominal pain, tarry stool, hematemesis, watery diarrhea	53	No description	69	2
Case 3	60, male, AML	Abdominal pain, watery diarrhea	62	Upper abdomen	73	143
Case 4	48, female, ML	Abdominal pain, watery diarrhea	36	Upper abdomen	31	10
Case 5	47, male, ML	Abdominal pain, watery diarrhea	30	Upper abdomen	32	4
Case 6	62, male, CML	Abdominal discomfort	NA	NA	47	32
Case 7	26, male, ML	Nausea, vomiting, abdominal discomfort	NA	NA	NA	01

¹CMV antigenemia remained negative throughout clinical course. CML: Chronic myelocytic leukemia; MDS: Myelodysplastic syndrome; AML: Acute myelocytic leukemia; ML: Malignant lymphoma.

Table 4 Endoscopic features in patients with and without CMV gastritis

Variables	Patients with CMV gastritis (n = 7)	Patients without CMV gastritis (n = 108)
Atrophic mucosa	3	36
Redness	5	100
Edema	2	9
Orange peel appearance	2	21
Mucosal sloughing	1	6
Erosion	6b	24b
Ulceration	0	2
Oozing	2a	3a

^aP = 0.029,

^bP = 0.0012.

Table 5 CMV inclusion bodies and response to ganciclovir of CMV gastritis

	Positive specimens with CMV inclusion bodies/total specimens in EGD biopsy				Response to ganciclovir		Outcome
	Total	Erosions	Mucosal sloughing	Other findings or normal mucosa	Abdominal pain	CMV antigenemia assay	Outcome	Cause of death
Case 1	1/2	1/2	None	0	Continued	Continued	Death	Bacterial pneumonia
Case 2	2/2	None	2/21	0	Improved	Turned negative	Death	Recurrence of primary disease
Case 3	2/3	2/31	None	0	Improved	Turned negative	Death	Renal failure
Case 4	5/7	4/4	None	12/3	Improved	Turned negative	Alive	NA
Case 5	1/5	1/1	None	0/4	Improved	Turned negative	Alive	NA
Case 6	4/7	3/3	None	12/4	NA	Turned negative	Alive	NA
Case 7	1/3	1/1	None	0/2	NA3	NA4	Death	Recurrence of primary disease
Case 7		26, male, ML		Nausea, vomiting, abdominal discomfort	NA	NA	NA	01

¹Oozing was accompanied in these findings;

²The patient was not given ganciclovir, but CMV gastritis improved spontaneously;

³The patient was not given ganciclovir, and CMV antigenemia remained negative throughout clinical course;

⁴The patient was not given ganciclovir, and CMV antigenemia remained negative throughout clinical course.