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. 2021 Jun;23(3):e13548.
doi: 10.1111/tid.13548. Epub 2021 Jan 5.

Cytomegalovirus (CMV) management in allogeneic hematopoietic cell transplantation: Pre-transplant predictors of survival, reactivation, and spontaneous clearance

Julian Lindsay  1   2 , Jad Othman  1 , Ian Kerridge  1   3 , Keith Fay  1 , William Stevenson  1   3 , Chris Arthur  1 , Sharon C-A Chen  2   4 , David C M Kong  5   6   7 , Steven A Pergam  8   9 , Catherine Liu  8   9 , Monica A Slavin  2   10   11 , Matthew Greenwood  1   3
Affiliations

Cytomegalovirus (CMV) management in allogeneic hematopoietic cell transplantation: Pre-transplant predictors of survival, reactivation, and spontaneous clearance

Julian Lindsay et al. Transpl Infect Dis. 2021 Jun.

Abstract

Background: Cytomegalovirus (CMV) reactivation is a frequent complication after allogeneic hematopoietic cell transplant (alloHCT).

Method: We analyzed 159 alloHCT recipients with 4409 quantitative CMV viral loads to determine pre-transplant predictors of CMV reactivation, clinically significant CMV infection (cs-CMVi, defined as CMV viral load >1000 IU/mL), CMV disease, kinetics of spontaneous clearance of CMV, and survival using a standardized pre-emptive therapy approach to identify at-risk groups to target prevention strategies.

Results: Cs-CMVi was most common in D-/R+ unrelated donor transplants (URD). Spontaneous CMV clearance occurred in 26% of patients who reached a viral load of 56-137 IU/mL, 6% at 138-250 IU/mL and in one patient >250 IU/mL. Median time between the first CMV reactivation (>56 IU/mL) and a viral load >250 IU/mL was 13 days, whereas the time from the first viral load >250 IU/mL to reach a vial load >1000 IU/mL was 4 days. Cs-CMVi was associated with a significant increase in non-relapse mortality (NRM) on multivariate analysis.

Conclusions: Overall, this study indicates that D-/R+ URD recipients are at high-risk for cs-CMVi- and CMV-related mortality, and are potential candidates for targeted CMV prophylaxis. Spontaneous clearance of CMV beyond a viral load of 250 IU/mL is uncommon, suggesting that this could be used as an appropriate threshold to initiate pre-emptive therapy.

Keywords: cytomegalovirus; hematopoietic cell transplantation; pre-emptive therapy; viremia.

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References

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