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. 2024 Jun:84:102039.
doi: 10.1016/j.trim.2024.102039. Epub 2024 Mar 19.

Predictors of cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation: Insights from a real-world experience

Matthew McGuirk  1 , Moazzam Shahzad  1 , Muhammad Kashif Amin  1 , Muhammad Atif Khan  1 , Polina Bellman  1 , Dinesh Pal Mudaranthakam  1 , Shaun DeJarnette  1 , Forat Lutfi  1 , Nausheen Ahmed  1 , Rajat Bansal  1 , Haitham Abdelhakim  1 , Chelsea Gorsline  1 , Dennis Matthew Shoemaker  1 , Al-Ola Abdallah  1 , Leyla Shune  1 , Sunil H Abhyankar  1 , Anurag K Singh  1 , Joseph P McGuirk  1 , Muhammad Umair Mushtaq  2
Affiliations
Free article

Predictors of cytomegalovirus reactivation after allogeneic hematopoietic cell transplantation: Insights from a real-world experience

Matthew McGuirk et al. Transpl Immunol. 2024 Jun.
Free article

Abstract

Background: We aimed to investigate factors associated with cytomegalovirus (CMV) viremia and CMV disease and its impact on post-transplant outcomes including overall survival (OS) following allogeneic hematopoietic stem cell transplantation (Allo-SCT).

Methods: We conducted a single-center retrospective study including 452 Allo-SCT recipients (matched unrelated donor, MUD 61%; haploidentical, haplo 39%) from 2016 to 2021. Data were analyzed using SPSS v28. Descriptive (chi-square and t-test), Kaplan-Meier and regression analyses were conducted.

Results: The median age was 57 years. Sixty-one percent were males and 84.3% were Caucasians. CMV serostatus was positive in 59.1% of recipients. The median follow-up was 24.4 months. CMV viremia and CMV disease were observed in 181 (40%) and 32 (7%) patients, respectively. Among CMV seropositive recipients, 65% developed CMV viremia and 11% were noted to have CMV disease compared to 4% and 1% in seronegative recipients, respectively (p < 0.001). Patients with CMV disease had significantly lower OS than those without CMV disease (median 14.1 months vs. not reached, p = 0.024); however, OS was not associated with CMV viremia (median not reached in both groups, p = 0.640). Letermovir prophylaxis was used in 66% (n = 176/267) of CMV seropositive recipients, but no impact was observed on the incidence of CMV viremia or CMV disease and OS.

Conclusions: CMV disease leads to significantly inferior survival after an allogeneic hematopoietic cell transplantation. Recipient CMV seropositive status was associated with the risk of CMV viremia and CMV disease, and this was not abrogated with the use of Letermovir prophylaxis.

Keywords: Allogeneic hematopoietic stem cell transplantation; Cytomegalovirus; Outcomes.

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Conflict of interest statement

Declaration of competing interest No relevant conflict of interest. SHA has speaking, consulting and advisory roles, and research funding from Incyte and Therakos. JPM has speaking, consulting and advisory role in Kite, Juno Therapeutics, Allovir, Magenta Therapeutics, EcoR1 Capital, and has research funding from Novartis, Fresenius Biotech, Astellas Pharma, Bellicum Pharmaceuticals, Gamida Cell, Pluristem Therapeutics, Kite and AlloVir. The remaining 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.