Abstract

Objective:Although Cytomegalovirus (CMV) infection is a major complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), the risk factors for CMV reactivation and treatment failure in CMV endemic areas have remained unclear. This study investigated the risk factors for CMV reactivation among allo-HSCT recipients in an area where CMV is highly endemic.Materials and Methods:Medical records of 82 allo-HSCT recipients from a CMV endemic area were retrospectively reviewed. The patients were stratified into two groups: those with CMV reactivation (n=32) and those without CMV reactivation (n=50). We investigated possible variables associated with CMV reactivation and treatment failure.Results:Univariate analyses showed that non-remission disease status [hazard ratio (HR): 2.15; p=0.032] and ≥grade III acute graft-versus-host disease (GVHD) (HR: 3.07; p=0.002) were associated with CMV reactivation. Multivariate analysis further demonstrated that older age (HR: 1.03; p=0.029) and ≥grade III acute GVHD (HR: 2.98; p=0.012) were associated with CMV reactivation. Overall survival time seemed lower among patients with CMV reactivation than among patients without CMV reactivation, although the difference was not statistically significant (p=0.165). The absence of ≥grade III acute GVHD was associated with successful CMV treatment in the current study (odds ratio: 4.40; p=0.008).Conclusion:Prophylactic anti-CMV therapy might need to be considered for allo-HSCT recipients who have ≥grade III GVHD.

Highlights

  • Allogeneic hematopoietic stem cell transplantation improves survival times in patients with acute myeloid leukemia [1] and acute lymphoid leukemia [2], but may be the only curative therapy for very severe aplastic anemia [3]

  • Univariate analyses showed that non-remission disease status [hazard ratio (HR): 2.15; p=0.032] and ≥grade III acute graftversus-host disease (GVHD) (HR: 3.07; p=0.002) were associated with CMV reactivation

  • Multivariate analysis further demonstrated that older age (HR: 1.03; p=0.029) and ≥grade III acute graft-versus-host disease (GVHD) (HR: 2.98; p=0.012) were associated with CMV reactivation

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Summary

Introduction

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) improves survival times in patients with acute myeloid leukemia [1] and acute lymphoid leukemia [2], but may be the only curative therapy for very severe aplastic anemia [3]. The morbidity and mortality that are associated with allo-HSCT limit its clinical application and efficacy. In addition to graft-versus-host disease (GVHD), infection remains one of the most important complications after allo-HSCT [4]. The incidence of each infection in allo-HSCT recipients varies depending on the time since transplantation. Cytomegalovirus (CMV) reactivation is the major infectious complication between 30 and 100 days after transplantation. Infections in the late phase are relatively heterogeneous, which is associated with the presence and severity of GVHD [5]

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