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Post-Transplant Events

Risk factors associated with late cytomegalovirus reactivation after allogeneic stem cell transplantation for hematological malignancies

Abstract

We analyzed the clinical factors associated with late cytomegalovirus (CMV) reactivation in a group of 269 consecutive recipients of allogeneic stem cell transplant (SCT) for hematological malignancies. Eighty-four subjects (31%) experienced late CMV reactivation, including 64 with prior early reactivation and 20 with isolated late reactivation. Multivariate analyses were conducted in patients with early CMV reactivation to identify factors associated with late recurrence. Important risk factors included lymphoid diagnosis, occurrence of graft-versus-host disease (GVHD), greater number of episodes of early reactivation, persistent day 100 lymphopenia and the use of a CMV-seronegative donor graft. We combined these risk factors in a predictive model to identify those at relatively low, intermediate and high risk. The low-risk group (15% cumulative incidence, CI) encompassed patients without early CMV reactivation, and subjects transplanted for a myeloid malignancy from a matched-related (MR) donor without subsequent acute GVHD. The high-risk patients (73% CI) met all of the following criteria: (1) received an MR graft but developed GVHD, or received a non-MR graft irrespective of GVHD; (2) had more than two episodes of early reactivation; and (3) received a CMV-seronegative graft and/or remained persistently lymphopenic at day 100 after SCT. The remaining patients had an intermediate incidence of 32%.

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Acknowledgements

We thank Agueda Cohen for efforts with data collection, and the clinicians and staff of the MD Anderson stem cell transplantation and cellular therapy program for their invaluable role in this study. This study was supported, in part, by funding from the US National Institutes of Health (NIH RO1 CA109326 to KVK and PO1 CA049639 to REC).

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Correspondence to K V Komanduri.

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Özdemir, E., Saliba, R., Champlin, R. et al. Risk factors associated with late cytomegalovirus reactivation after allogeneic stem cell transplantation for hematological malignancies. Bone Marrow Transplant 40, 125–136 (2007). https://doi.org/10.1038/sj.bmt.1705699

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