Journal Article

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

Champlin, R E, Giralt, S A, de Lima, M, Hosing, C, Anderlini, P, Özdemir, E, Qazilbash, M H, Kornblau, S M, Chemaly, R F, Molldrem, J J, Couriel, D R, Shpall, E J, Komanduri, K V, Saliba, R M, Khouri, I F

2007

Overview

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%.

• Publisher: Nature Publishing Group
• Subject: Adolescent / Adult / Aged / Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy / Biological and medical sciences / Bone marrow / Bone marrow, stem cells transplantation. Graft versus host reaction / Care and treatment / Complications and side effects / Cytomegalovirus / Cytomegalovirus Infections - etiology / Cytomegaloviruses / Female / Graft versus host disease / Graft versus host reaction / Graft vs Host Disease - etiology / Grafting / Health aspects / Hematologic Neoplasms - immunology / Hematologic Neoplasms - therapy / Hematology / Histocompatibility Testing / Humans / Lymphopenia / Male / Malignancy / Medical sciences / Middle Aged / Multivariate Analysis / Patients / Prediction models / Recurrence / Risk analysis / Risk Factors / Risk groups / Stem cell transplantation / Stem Cell Transplantation - adverse effects / Stem cells / T-Lymphocytes - immunology / Time Factors / Transfusions. Complications. Transfusion reactions. Cell and gene therapy / Transplantation / Transplantation, Homologous / Transplants & implants