Risk factors and survival of refractory cytomegalovirus reactivation after allogeneic peripheral blood stem cell transplantation

Abstract

Refractory cytomegalovirus reactivation (RCR) after allo-hematopoietic stem cell transplantation (HSCT) is associated with poor outcomes. Current studies for the risk factors and survival of patients with post-transplantation RCR remain limited. 163 patients with Cytomegalovirus (CMV) reactivation undergoing allo-HSCT in Jiangsu Province hospital from Jan 2013 to Dec 2020 were analyzed retrospectively. Multivariate analysis revealed that highest CMV viremia>1×104copies/mL (hazard ratio [HR] 16.895, 95% confidence interval [CI] 3.394-84.109, P=0.001) and platelet count at Day 90 of more than 87.3×109/L (HR 0.381, 95% CI 0.154-0.945, P=0.037) were independent risk factors affecting RCR. As for prognosis of patients with CMV reactivation, results showed that patients with RCR had higher risk of non-relapse mortality (NRM) (39.5% vs. 22.5%, P=0.045), and RCR was an independent risk factor for NRM (HR 2.216, 95% CI 1.137-4.317, P=0.019). There was no significance between patients with or without RCR in terms of overall survival (OS) (50.7% vs. 55.6%, P=0.281) and relapse-free survival (RFS) (43.6% vs. 52.0%, P=0.179). The landmark analysis showed that patients with RCR had higher NRM (P=0.01), worse OS (P=0.02), and RFS (P =0.01) within 100 days after transplantation. Patients with hemorrhagic cystitis (40.9% vs. 64.5%, P =0.028) and who developed viremia>1×105copies/mL (43.4% vs. 58.4%, P=0.033) were associated with worse OS. Factors such as higher viral load, thrombocytopenia, and ATG used in conditioning therapy increased the incidence of RCR. Patients with RCR had worse NRM, OS, and RFS within 100 days after transplantation.