Clinically Significant Gastrointestinal Toxicity As A Determinant of Prolonged Hospitalization After Autologous Stem Cell Transplantation - A Single-Centre Retrospective Cohort Study

Abstract

Background: Gastrointestinal (GI) toxicity following autologous stem cell transplantation (ASCT) is common but its contribution to prolonged hospitalization remains poorly defined. We examined the association between clinically significant GI toxicity and early transplant outcomes including prolonged hospital stay in a real-world cohort of hematologic malignancy patients.
Methods: Single-centre retrospective cohort study of 50 consecutive ASCT recipients conducted between April 2022 and December 2025. Clinically significant GI toxicity was defined as grade ≥2 oral mucositis and/or grade ≥2 diarrhea according to Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The primary endpoint was prolonged hospitalization (>22 days). Univariate odds ratios were calculated for prolonged hospital stay; an exploratory multivariable logistic regression model included GI toxicity, BEAM conditioning, febrile neutropenia, and culture positivity.
Results: Clinically significant GI toxicity occurred in 26 patients (52.0%): grade ≥2 diarrhea in 24 patients (48.0%) and grade ≥2 mucositis in 12 patients (24.0%). Patients with significant GI toxicity had a median hospital stay of 22 days versus 18 days in those without (p=0.065). The strongest univariate predictors of prolonged hospitalization (>22 days) were febrile neutropenia (OR 32.00, 95% CI 5.59–183.03, p<0.001), BEAM conditioning (OR 15.44, 95% CI 2.81–84.72, p<0.001), and culture positivity (OR 6.57, 95% CI 1.51–28.54, p=0.013). In exploratory multivariable analysis, febrile neutropenia and culture positivity retained strong effect sizes but were borderline significant (p=0.060 and p=0.063, respectively).
Conclusions: Clinically significant GI toxicity is highly prevalent after ASCT but prolonged hospitalization is driven primarily by infectious complications and conditioning intensity. BEAM-conditioned patients represent a high-risk subgroup requiring intensified supportive care and proactive discharge planning. These exploratory findings should be validated in larger prospective cohorts.