CMV-IgG pre-allogeneic hematopoietic stem cell transplantation and the risk for CMV reactivation and mortality

Abstract

Cytomegalovirus (CMV) represents one of the most common infectious complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Currently, a common diagnostic test used to stratify the risk for CMV infection in allo-HSCT recipients is the qualitative CMV serology of donor and recipient. A positive serostatus of the recipient is the most important risk factor for CMV reactivation and associated with reduced overall survival post-transplantation (TX). Direct and indirect effects of CMV are involved in the poorer survival outcome. The present study investigated if the quantitative interpretation of anti-CMV IgG before allo-HSCT might serve as a novel parameter for the identification of patients at risk for CMV reactivation and worse outcome post-TX. For this purpose, a cohort of 440 allo-HSCT recipients over a period of 10 years was retrospectively analyzed. Our findings indicated that patients with high CMV IgG pre-allo-HSCT had a higher risk to develop CMV reactivation, including clinically relevant infections, and a worse prognosis 36 months post-allo-HSCT as compared to recipients with low CMV IgG values. In the letermovir (LMV) era, this group of patients might benefit from a closer CMV monitoring, and hence, earlier intervention if needed, especially after discontinuation of prophylaxis.

Torque teno virus‐DNA load as individual cytomegalovirus risk assessment parameter upon allogeneic hematopoietic stem cell transplantation

“…According to this evidence, lower TTV‐DNA levels shortly after engraftment were already reported in allo‐HSCT recipients developing a high‐level CMV DNAemia 24 . Furthermore, in accordance with previous observations, a CMV‐positive serostatus of the recipient was correlated with a poorer prognosis in our cohort 32,33 …”

“…24 Furthermore, in accordance with previous observations, a CMV-positive serostatus of the recipient was correlated with a poorer prognosis in our cohort. 32,33 In our cohort a limited number of patients showed no or first CMV reactivation/infection.…”

Human virome profiling identified CMV as the major viral driver of a high accumulation of senescent CD8 + T cells in patients with advanced NSCLC

“…Our data only relate to viral replication at a particular moment and does not reflect the number of reactivations that each patient may have experienced. To better address this question, we measured anti-CMV IgG titers because high titers were associated with a higher risk of developing CMV reactivation ( 35 , 36 ). We demonstrated that higher titers were associated with enrichment of T 8 sen, suggesting repetitive immunological stimulation by CMV in T 8 sen high patients.…”

“…Median age across all cohorts included in the clinical analysis was 63. 35 (31.50 to 92.86) years old. Patients had a median of 2 (0 to 7) metastatic sites.…”

Reexploring cytomegalovirus serology in allogeneic hematopoietic cell transplantation

“…In a single-center 13-year cohort study, we reviewed the impact of pretransplant CMV IgG titers on CMV replication during the first 180 days posttransplant in 422 allogeneic HCT CMV Rþ (294 Dþ/Rþ and 128 DÀ/Rþ). The median Additional data from an elaborate discovery and validation cohort study were recently presented at the 50 th annual meeting of the European Bone Marrow Transplant (EBMT) Society by the Seattle group [8]. Pretransplant sera from 478 allogeneic HCT DÀRþ patients between 2007 and 2017, before the introduction of letermovir in clinical practice, were tested for CMV-specific humoral immunity by display immunoprecipitation and sequencing (Vir-Scan).…”