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. 2022 Mar 22:12:862526.
doi: 10.3389/fcimb.2022.862526. eCollection 2022.

A Predicted Model for Refractory/Recurrent Cytomegalovirus Infection in Acute Leukemia Patients After Haploidentical Hematopoietic Stem Cell Transplantation

Meng-Zhu Shen  1 , Shen-Da Hong  2 , Jie Wang  1   3 , Xiao-Hui Zhang  1 , Lan-Ping Xu  1 , Yu Wang  1 , Chen-Hua Yan  1 , Huan Chen  1 , Yu-Hong Chen  1 , Wei Han  1 , Feng-Rong Wang  1 , Jing-Zhi Wang  1 , Kai-Yan Liu  1 , Xiao-Jun Huang  1   4   5 , Xiao-Dong Mo  1   5
Affiliations

A Predicted Model for Refractory/Recurrent Cytomegalovirus Infection in Acute Leukemia Patients After Haploidentical Hematopoietic Stem Cell Transplantation

Meng-Zhu Shen et al. Front Cell Infect Microbiol. .

Abstract

Objective: We aimed to establish a model that can predict refractory/recurrent cytomegalovirus (CMV) infection after haploidentical donor (HID) hematopoietic stem cell transplantation (HSCT).

Methods: Consecutive acute leukemia patients receiving HID HSCT were enrolled (n = 289). We randomly selected 60% of the entire population (n = 170) as the training cohort, and the remaining 40% comprised the validation cohort (n = 119). Patients were treated according to the protocol registered at https://clinicaltrials.gov (NCT03756675).

Results: The model was as follows: Y = 0.0322 × (age) - 0.0696 × (gender) + 0.5492 × (underlying disease) + 0.0963 × (the cumulative dose of prednisone during pre-engraftment phase) - 0.0771 × (CD34+ cell counts in graft) - 1.2926. The threshold of probability was 0.5243, which helped to separate patients into high- and low-risk groups. In the low- and high-risk groups, the 100-day cumulative incidence of refractory/recurrent CMV was 42.0% [95% confidence interval (CI), 34.7%-49.4%] vs. 63.7% (95% CI, 54.8%-72.6%) (P < 0.001) for total patients and was 50.5% (95% confidence interval (CI), 40.9%-60.1%) vs. 71.0% (95% CI, 59.5%-82.4%) (P = 0.024) for those with acute graft-versus-host disease. It could also predict posttransplant mortality and survival.

Conclusion: We established a comprehensive model that could predict the refractory/recurrent CMV infection after HID HSCT.

Clinical trial registration: https://clinicaltrials.gov, identifier NCT03756675.

Keywords: cytomegalovirus; haploidentical donor; hematopoietic stem cell transplant; predicted model; refractory.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of building the machine learning model.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve and confusion matrix for refractory/recurrent cytomegalovirus (CMV) infection model in the training (A) and validation cohorts (B).
Figure 3
Figure 3
The 100-day cumulative incidence of refractory/recurrent (A) and total (B) cytomegalovirus (CMV) infection in the low- and high-risk groups.
Figure 4
Figure 4
The 100-day cumulative incidence of refractory/recurrent cytomegalovirus (CMV) infection in patients without acute graft-versus-host disease (aGVHD) (A) and with aGVHD (B).
Figure 5
Figure 5
The 1-year cumulative incidence of relapse (A), non-relapse mortality (NRM; B), leukemia-free survival (LFS; C), and overall survival (OS; D) in the low- and high-risk groups.
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