mortality, compared with PtCy and non-PtCy UCBT. This effect was independent of other relevant variables. The shorter time to neutrophil and platelet engraftment and no increase of aGVHD could explain the decrease in early mortality. The impact of this approach over cGvHD and long-term mortality is uncertain at this moment; nevertheless, we have no evidence of increased relapse in acute leukemia. Although further studies are necessary, dual-PtCy could be an alternative for patients without matched sibling donor.
Baseline characteristic are shown in Table 1. The median follow up was 22 months. The median PFS and OS for the patient cohort was 12 months and 20 months respectively (Figure 1A, 1B). Of the 178 patients undergoing haplo-SCT 166 were at risk of CMV reactivation. Of these patients 103 (62%) had CMV reactivation with a median time to reactivation of 39 days (range 1-716). Ten patients had CMV disease (2-pneumonia, 3-colitis, 2-upper respiratory infections, 1-esophagitis, 2-retinitis). 71% (74/104) of patients with both donor (D) and recipient (R) CMV IgG positive (D+/R+) had CMV reactivation, 10% (1/10) were D+/R-and 54% (28/ 52) where the D-/R+. The cumulative incidence (CI) of reactivation at 2-years was highest (70%) for D+/R+ with p<0.001 (Figure 1D). There was no difference in the CI of reactivation for CMV or BK based on the conditioning regimen (p ¼ 0.499). On multivariate analysis a low CD8+ T cell count at day +90 correlated with a higher incidence of CMV reactivation (p¼0.016) (Figure 1G). Seventy-three of the 178 patients (41%) had symptomatic BK viral reactivation with 43 patients (24%) having significant grade 2-4 BK cystitis and 15 patients (8%) had severe cystitis requiring continuous bladder irrigation and/or nephrostomy tube placement (Figure 1E). Fifty-four patients (65%) with symptomatic BK reactivation had coinfection with CMV versus 35% without CMV reactivation (p¼0.023). On univariate analysis neither the CMV nor BK viral reactivation was associated with worsened survival outcomes. Discussion: Within the limitations of a retrospective study we have shown a high incidence of viral reactivations amongst TCR haplo-SCT recipients. This study supports the need for prospective clinical trials to evaluate the role of prophylactic/preemptive anti-viral therapy in high risk patients.
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