Clinical and economic impact of treated CMV infection in adult CMV‐seropositive patients after allogeneic hematopoietic cell transplantation

Abstract

Objective Recipients of allogeneic hematopoietic stem cell transplantation (allo‐HCT) with positive cytomegalovirus (CMV) serology are at increased risk of morbidity and mortality. The primary objective of this study was to assess the association between treated CMV infection and overall mortality within 1 year after allo‐HCT in adult CMV‐seropositive Recipients (R+). Secondary objectives included overall 5‐year mortality after allo‐HCT, risk factors for treated CMV infection, associations between treated CMV infection and allo‐HCT complications and medical costs. Methods A multicenter retrospective cohort study was conducted in adult CMV‐seropositive recipients (R+) who underwent to allo‐HCT between 1st January 2010 and 31st December 2014. Results Five hundred seventy two CMV‐seropositive patients (mean age, 50.2 years) undergoing allo‐HCT between 2010 and 2014 were included; 55.9% of donors were CMV seropositive. CMV infection treated with antiviral therapy was reported in 227 patients (39.7%) after transplantation. One‐year overall mortality was significantly increased in patients with treated CMV infections (hazard ratio, 1.86; 95% CI, 1.16‐3.00; P = .011). Mean medical costs during the first post‐HCT year were higher in patients with CMV infection (€46 853 vs €31 318; P < .0001). Conclusion In this large cohort of CMV‐seropositive patients undergoing allo‐HCT, treated CMV infection was significantly associated with an increased 1‐year risk of overall mortality, with increased length of stay and with hospitalization cost. The burden of CMV disease in allo‐HCT could be reduced in the future by appropriate prophylactic strategies.

Treatment for First Cytomegalovirus Infection Post–Hematopoietic Cell Transplant in the AURORA Trial: A Multicenter, Double-Blind, Randomized, Phase 3 Trial Comparing Maribavir With Valganciclovir

“…Pre-emptive treatment for CMV following HCT is generally effective in preventing CMV tissue-invasive disease (ie, end-organ disease) but is associated with dose-limiting toxicities (eg, myelotoxicity for valganciclovir/ganciclovir and renal toxicity for foscarnet and cidofovir [ 5–9 ]), often requiring dose adjustment, interruption, or cycling of therapies, thereby impacting CMV recurrence and patient outcomes [ 10 , 11 ]. Additionally, management of treatment-related toxicities with growth-factor support, hydration, intensive electrolyte monitoring, and replacement poses a substantial burden on both the healthcare system and patients [ 3 , 10 ]. Therefore, there is a need for new agents with fewer safety concerns for CMV management in HCT recipients.…”

The promising efficacy of a risk-based letermovir use strategy in CMV-positive allogeneic hematopoietic cell recipients

“…But, overall, a dynamic strategy that adapts to each patient's changing risk could make letermovir more cost-effective. 47 , 48 …”

How to improve the outcomes of elderly acute myeloid leukemia patients through allogeneic hematopoietic stem cell transplantation

“…CMV is the most typical post-transplant viral infection. Patients who received MAC had a higher risk of getting infected with CMV than those who received NMA or RIC ( 91 ), and those who used much of cortisol hormone, cyclosporin, ATG, or other immunosuppression had a higher risk as well. Because their immune systems are more weakened and CMV disease has a worse prognosis, older people are more prone to get infect with it.…”