Risk factors for cytomegalovirus DNAemia following haploidentical stem cell transplantation and its association with host hepatitis B virus serostatus

Abstract

BackgroundThe risk factors associated with CMV DNAemia are not well known after haploidentical stem cell transplantation (SCT). ObjectivesThis study investigated the risk factors and prognosis for CMV DNAemia among CMV seromatched donors and recipients (D+/R+). Study designA retrospective study of patients undergoing haploidentical stem cell transplantation (SCT) between January 2010 and January 2012 was conducted. Cox regression analysis was performed to identify the risk factors for CMV DNAemia. These possible factors included recipient/donor age, recipient/donor gender, gender disparity, recipient HBsAg serostatus, diagnosis, risk stratification, anti-thymocyte globulin (ATG) dose (6mg/kg,10mg/kg), early neutrophil engraftment (≤12 days, >12 days), absolute lymphocyte count on day 30 (ALC30) and the occurrence of acute GVHD before CMV DNAemia. ResultsThe total number of patients was 248 with median age of 31 years (range, 14–56). The cumulative incidence of CMV DNAemia (146/248) was 59.5%. CMV DNAemia was first detected after a median of +35 days (range,12–82). Seventeen patients (17/146, 11.6%) developed CMV disease. Multivariate analysis identified HBsAg seropositivity (P=0.002, hazard ratio (HR)=1.833; 95%CI=1.257–2.673) and the occurrence of acute GVHD before CMV DNAemia (P=0.014; HR=1.520; 95%CI=1.088–2.124) as risk factors for CMV DNAemia. CMV DNAemia was associated with subsequent II-IV acute graft-versus-host disease (GVHD) (P=0.014), III-IV aGVHD (P=0.013) and chronic GVHD (P=0.008). Totally, CMV DNAemia was found to be a poor prognostic factor in terms of non-relapse mortality (NRM) (P=0.003, HR=2.730; 95%CI=1.406–5.197), and overall survival (OS) (P=0.045, HR=1.654; 95%CI=1.012–2.701). ConclusionsOur data showed HBsAg seropositivity was associated with an increased risk of cytomegalovirus DNAemia. Detection of CMV DNAemia proved to be a poor prognostic factor for haploidentical patients.