Background of CMV infection in HSCT
Hematopoietic stem cell transplant (HSCT) patients are at increased risk for cytomegalovirus (CMV) infection, disease, and associated mortality1–4
Positive CMV serostatus pre-HSCT is a strong predictor of CMV infection and disease.1,2
- CMV infection has been shown to occur in ~30-65% of CMV-seropositive allogeneic HSCT patients.3,5
- More than 30% of HSCT patients who were CMV-seropositive or had a seropositive donor had CMV infection within 1 month post-transplant.4
Any level of CMV viremia is associated with increased risk of mortality in the first year post-HSCT4,a
CMV viral load as a time-dependent risk factor for overall mortality 1 year after HSCT (n=926)4
CI, confidence interval; HR, hazard ratio.
(a) Results from a large, retrospective, noninterventional cohort study of previously collected CMV viral load and clinical outcome measures (n=926).4
Early CMV reactivation is associated with increased non-relapse mortality and reduced overall survival following allogeneic HSCT5
Adapted from a CIBMTR analysis by Teira et al.
ALL, acute lymphoblastic leukemia; AML, acute myeloid leukemia; CIBMTR, Center for International Blood and Marrow Transplant Research; CML, chronic myeloid leukemia; MDS, myelodysplastic syndrome.
- No data was collected on how CMV reactivation was monitored with respect to tests used and values applied for implementing preemptive therapy.5
- Institutional practices for preemptive and prophylactic therapy vary with respect to initiation and duration of therapy, affecting the ability to assess efficacy of initial therapy and duration of CMV reactivation.5
- The retrospective nature of the analysis limits generalization of results across transplant settings.5
- Retrospective, multivariate analysis of 9,469 patients from the Center for International Blood and Marrow Transplant Research (CIBMTR) database who received their first allogeneic HSCT between 2003 and 20105
- Multivariable analysis of risk factors for outcomes depending on CMV serostatus and reactivation with hematologic disease relapse, non-relapse mortality, and overall survival (AML [n=5,310], ALL [n=1,883], CML [n=1,079], and MDS [n=1,197])5
How could initiation of CMV prophylaxis make a difference for your adult R+ patients?
- George B, Pati N, Gilroy N, et al. Pre-transplant cytomegalovirus (CMV) serostatus remains the most important determinant of CMV reactivation after allogeneic hematopoietic stem cell transplantation in the era of surveillance and preemptive therapy. Transpl Infect Dis. 2010;12(4):322–329.
- Ljungman P, Hakki M, Boeckh M. Cytomegalovirus in hematopoietic stem cell transplant recipients. Hematol Oncol Clin North Am. 2011;25(1):151–169.
- Sousa H, Boutolleau D, Ribeiro J, et al. Cytomegalovirus infection in patients who underwent allogeneic hematopoietic stem cell transplantation in Portugal: a five-year retrospective review. Biol Blood Marrow Transplant. 2014;20(12):1958–1967.
- Green ML, Leisenring W, Xie H, et al. Cytomegalovirus viral load and mortality after haematopoietic stem cell transplantation in the era of pre-emptive therapy: a retrospective cohort study. Lancet Haematol. 2016;3(3):e119–e127.
- Teira P, Battiwalla M, Ramanathan M, et al. Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: a CIBMTR analysis. Blood. 2016; 127(20)2427-2438. doi:10.1182/blood-2015-11-679639