Incidence and Impact of Cytomegalovirus in Hematopoietic Cell Transplant Recipients at a Single Center over the Last Decade

Abstract

<h3>Objective</h3> CMV continues to have a significant impact on HCT despite preemptive antiviral (PET) strategies. Our objective was to assess the incidence and impact of CMV in HCT recipients. <h3>Methods</h3> We performed a retrospective analysis of 1109 seropositive adults who underwent HCT at Stanford University from Jan 2009-May 2019 (Fig. 1). Plasma CMV PCR screening was performed weekly through D+100; from 2009-2012, high risk patients received valganciclovir or ganciclovir. Umbilical cord blood (UCB) recipients received valacyclovir 2000 mg thrice daily. PET was instituted if viral load (VL) was > 400 copies/ml (2009-2012) or >400 IU/ml (2013-2019). CMV disease was defined by published criteria. <h3>Results</h3> Highlights of our observations: • Despite higher frequency of detectable low-level DNAemia and high-risk transplants, CMV disease has decreased over the last decade (Fig. 2). • Between 2009-2012, 41 patients received CMV prophylaxis (22% VGC 9, 73% GCV, 5% FOS; N=3 received PET; N=1 CMV disease); 53% who did not receive prophylaxis received PET. • Following myeloablative regimens, R+/D- were twice as likely to receive PET, regardless of protocol or donor but were not more likely to develop CMV disease (Table 1a). • ATG group had earlier reactivation (median D+11, range 0-68), higher peak VL and increased incidence of disease (8%). 7% of UCB and haplo who reactivated, did so between D+100-180 (vs 2% ATG). • In 19% of patients only low-grade DNAemia (<135 IU/ml or <150 copies/ml) was ever detected; of those 86% resolved spontaneously and only 2.4% had contemporaneous CMV disease. • Patients for whom CMV therapy was initiated during a hospitalization had higher median total number of admissions and higher number of inpatient days within the first year (Table 1b). <h3>Conclusion</h3> Despite PET, CMV continues to have a measurable impact on HCT patients. Other analyses include the significance of low grade VL, area under the curve of DNAemia, peak viremia, transfusion requirements, infections, and relapse.