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Prognostic impact of histopathologic features including histological grading and immunohistochemistry-positive cell counts in cytomegalovirus-gastrointestinal disease after allogeneic hematopoietic cell transplantation

Bone Marrow Transplantation volume 60, pages 1190–1192 (2025)Cite this article

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Cytomegalovirus (CMV)-gastrointestinal (GI) disease often occurs concomitantly with graft-versus-host disease (GVHD) and is associated with poor outcomes after allogeneic hematopoietic cell transplantation (HCT) [1,2,3]. Although letermovir prophylaxis has reduced the incidence of CMV reactivation and GI disease, CMV-GI disease remains the most prevalent CMV-related breakthrough condition and continues to be a critical complication associated with increased mortality after allogeneic HCT [4, 5].

Diagnosing CMV-GI disease is challenging because it can develop without CMV viremia or antigenemia, presenting GI symptoms and histological findings on hematoxylin and eosin (H&E) staining that are similar to GI-GVHD [6, 7]. An accurate diagnosis of GI-CMV disease requires a thorough understanding of its histopathological features. However, no study has systemically examined the histopathological characteristics of CMV-GI disease and its association with clinical outcomes. Therefore, we conducted a detailed histopathological evaluation of GI endoscopic biopsy specimens from allogeneic HCT recipients to explore the association between histopathological features of CMV-GI disease and subsequent outcomes.

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Fig. 1: Histology of lower gastrointestinal tract biopsy with typical CMV disease.

Data availability

The data that support the findings of this study are available from the corresponding author upon request.

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Acknowledgements

This work was supported by the National Cancer Center Research and Development Fund (2023-A-16), and Japanese Society for the Promotion of Science KAKENHI (23K14657).

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Authors and Affiliations

  1. Department of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

    Masatomo Kuno, Takashi Tanaka, Ayumu Ito, Yoshihiro Inamoto, Sung-Won Kim & Takahiro Fukuda

  2. Department of Hematology, Osaka Metropolitan University Graduate School of Medicine, Osaka, Japan

    Masatomo Kuno

  3. Department of Hematology, Osaka Keisatsu Hospital, Osaka, Japan

    Takashi Tanaka

  4. Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan

    Akiko Miyagi Maeshima

  5. Endoscopy Division, National Cancer Center Hospital, Tokyo, Japan

    Hiroyuki Takamaru & Yasuo Kakugawa

  6. Cancer Screening Center, National Cancer Center Hospital, Tokyo, Japan

    Yasuo Kakugawa

Authors
  1. Masatomo Kuno
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  2. Takashi Tanaka
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  9. Takahiro Fukuda
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Contributions

MK, TT, AMM, and TF contributed to the study conception and design. MK cleaned the data. MK, TT, and AMM analyzed the data, interpreted the results, and wrote the manuscript. HT, YK, AI, YI, SWK, and TF interpreted the results and critically reviewed and revised the manuscript. All the authors have read and approved the final version of the manuscript.

Corresponding author

Correspondence to Takashi Tanaka.

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Competing interests

The authors declare no competing interests.

Ethical approval and consent to participate

This study was approved by the National Cancer Center Hospital ethical committee and was conducted in accordance with the Declaration of Helsinki. Informed consent was obtained from all participants.

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Kuno, M., Tanaka, T., Maeshima, A.M. et al. Prognostic impact of histopathologic features including histological grading and immunohistochemistry-positive cell counts in cytomegalovirus-gastrointestinal disease after allogeneic hematopoietic cell transplantation. Bone Marrow Transplant 60, 1190–1192 (2025). https://doi.org/10.1038/s41409-025-02621-2

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