Cytomegalovirus After HCT Does Not Protect Against Leukemia Relapse

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Cytomegalovirus reactivation after hematopoietic cell transplantation continued to be associated with poorer survival.
Cytomegalovirus reactivation after hematopoietic cell transplantation continued to be associated with poorer survival.

Cytomegalovirus (CMV) reactivation after hematopoietic cell transplantation (HCT) continued to be associated with poorer survival, a study published in the journal Blood has shown; however, it prevented leukemia relapse.1

Because single-center studies have demonstrated an association between early CMV reactivation before day 100 and reduced incidence of relapse for acute myeloid leukemia (AML) after allogeneic HCT, researchers sought to substantiate these claims by conducting a retrospective study.

For the study, researchers analyzed data from 9469 patients transplanted with bone marrow or peripheral blood between 2003 and 2010 who were included in the Center for International Blood and Marrow Transplant Research (CIBMTR) Database.

Patients were treated for AML, acute lymphoblastic leukemia (ALL), chronic myeloid leukemia (CML), or myelodysplastic syndrome (MDS).

Researchers found that the median time to initial CMV reactivation was 41 days (range, 1 - 362 days).

Results showed that regardless of diagnosis, CMV reactivation had no preventive impact on hematologic disease relapse.

Further, CMV reactivation was associated with increased non-relapse mortality (RR range among disease categories, 1.61 - 1.95; 95% CI, 1.14 - 2.61; P = .0002 to < .0001).

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That increase in non-relapse mortality caused lower overall survival for all 4 hematologic malignancies (RR, 1.27; 95% CI, 1.17 - 1.38; P < .0001), ALL (RR; 1.46; 95% CI, 1.25 - 1.71; P < .0001), CML (RR, 1.49; 95% CI, 1.19 - 1.88; P = .0005), and MDS (RR, 1.31; 95% CI, 1.09 - 1.57; P = .003).

Reference

  1. 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 [published online ahead of print February 16, 2016]. Blood. doi: 10.1182/blood-2015-11-679639.

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