Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

Lin, Hsin‐Chen; Han, Shao Min; Hwang, Wen Li; Chou, Cheng Wei; Chang, Kuang-Hsi; Shi, Zhi Yuan; Teng, Chieh Lin Jerry

doi:10.4274/tjh.2016.0225

Cited by 15 publications

(18 citation statements)

References 23 publications

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“…A comparable result was obtained in the univariate analysis in our study, but not in the multivariate analysis, which showed that ATG does not significantly increase the risk of CMV DNAemia (HR: 1.32; 95% CI: 0.50‐3.51; P = 0.571). Although our previous findings further suggest that ATG alone is not positively associated with CMV in allo‐HSCT (HR: 0.93; 95% CI: 0.41‐2.13; P = 0.865), a small sample size could explain the differences among studies. Immunosuppression by PTCY is another consideration.…”

Section: Discussioncontrasting

confidence: 61%

Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia

Lin

Hsu

et al. 2019

Transplant Infectious Dis

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Background:Owing to the shortage of hematopoietic stem cells from matched sibling donors (MSD) and matched unrelated donors (MUD), the number of patients undergoing haploidentical allogeneic hematopoietic stem cell transplantation (allo-HSCT) has rapidly increased. Despite a comparable overall survival (OS) and leukemia-free survival using this approach, some evidence suggests that haploidentical allo-HSCT recipients have a higher incidence of cytomegalovirus (CMV) infection, though this has not been clearly established. Methods:This study retrospectively compared the cumulative incidence of CMV DNAemia, 2-year OS, and leukemia-free survival rates in acute leukemia patients with MSD (n = 41), MUD (n = 18), and haploidentical donor allografts (n = 21). Results:The cumulative incidences of CMV DNAemia at day 180 in the MSD, MUD, and haploidentical groups were 39.0, 55.6, and 85.7%, respectively (P < 0.000). As less than 50% of patients in the MSD group were detected to have CMV DNAemia, the median time to CMV DNAemia detection in patients allografted with MSD could not be obtained. However, it was 42 and 29 days, respectively, for the MUD and haploidentical groups. Multivariate analysis revealed that haploidentical allo-HSCT (MSD vs. haploidentical: HR: 0.26; 95% CI: 0.09-0.78; P = 0.017) and age (HR: 1.03; 95% CI: 1.01-1.06; P = 0.011) increased CMV infection. Finally, MSD, MUD, and haploidentical allo-HSCT provided comparable 2-year OS rates (52.1%, 65.5%, and 65.6%; P = 0.425) and 2-year leukemia-free survival rates (67.1%, 68.3%, and 80.7%, P = 0.837). Conclusion:The CMV incidence was higher for haploidentical allo-HSCT than for MSD and MUD allo-HSCT; this could be explained by graft-versus-host disease prophylaxis by multiple immunosuppressants. K E Y W O R D Sallo-HSCT, haploidentical, cytomegalovirus, overall survival, leukemia-free survival

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Section: Discussioncontrasting

confidence: 61%

Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia

Lin

Hsu

et al. 2019

Transplant Infectious Dis

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“…14% of patients with GVHD of Grade 2 or higher demonstrated high levels of CMV positivity; having GVHD of Grade 2 or higher was identified as a strong risk factor for CMV infections (p= 0.035) [22]. Similarly, Lin et al reported that the presence of acute GVHD of Grade 3 or higher resulted in a 2.98-fold increase in CMV reactivation (19). Broers et al identified symptomatic CMV disease as an independent risk factor for acute GVHD, but did not determine a significant relationship between chronic GVHD and CMV reactivation [23].…”

Section: Discussionmentioning

confidence: 95%

“…Using RIC HSCT, Alemtuzumab, and Acute GVHD have been identified as risk factors for CMV viremia (13). While some studies reported lower CMV incidences in patients treated with an NMA conditioning regimen [16][17][18], others have mentioned increased incidence rates [19]. On the other hand, Oh and colleagues did not determine a relationship between CMA viremia and the use of NMA or MA conditioning regimens [20].…”

Section: Discussionmentioning

confidence: 99%

“…Another study reported viral load, CMV-specific T cell immune failure, and lymphopenia as a cause of mortality in the late period (9). Lin et al reported that CMV viremia was not a factor that affected mortality and survival (19). In our study, mortality was encountered in three (3.3%) allogeneic transplant patients with CMV viremia in the early period and in 10 (11.1%) in the late period, whereas it was encountered in 10 (13.2%) without viremia in the early period and in 19 (25%) in the late period.…”

Section: Discussionmentioning

confidence: 99%

“…Despite serologic CMV positivity, systemic CMV infections were encountered in only two (1.2%) allogeneic HSCT patients and in the form of CMV colitis. In allogeneic transplant patients; the median time of thrombocyte engraftment was day 16 for the group detected to have viremia (range 12-63 days) and the median time of neutrophil engraftment was day 15 (range [11][12][13][14][15][16][17][18][19][20][21], whereas for the CMV PCR negative group, the median time…”

Section: Clinic Effects Of CMV Viremia On Allogeneic Hsctmentioning

confidence: 99%

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Cytomegalovirus Reactivation in Hematopoietic Stem cell Transplantation managed by Preemptive Treatment with lower dose Valganciclovir

Akyol¹,

Şahin²

2019

IJHBD

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Objective: The aim of this study was to investigate risk factors for cytomegalovirus (CMV) infection, effect of viral reactivation on hematopoietic stem cell transplantation (HSCT) and efficacy of preemptive treatment using a lower dose valganciclovir for the first time. Material and Method:The data of 447 patients who underwent HSCT for malignant and non-malignant hematological disorders at a single center from September 2009 to December 2016 were retrospectively evaluated in this study. DNA levels of CMV were routinely tested two days per week for the first 24 months following HSCT, and in case of clinical suspicion after 24 months using the Quantitative Real-Time quantitative polymerase chain reaction (RT-PCR).Results: Ninety (54.2%) allogeneic transplant patients, and forty one (14.6%) autologous transplant patients had CMV reactivation. There was a statistically significant increase in CMV reactivation in the non-myeloablative (NMA) allogeneic transplant group compared to the myeloablative (MA) group at a value of 150-1000 copies/mL CMV-PCR (p= 0.002). Acute/chronic Graft Versus Host Disease (GVHD) were observed in 30 of allogeneic HSCT patients. 29 of these patients (96.6%) had CMV antigenemia. There was a significant association between the development of acute/ chronic GVHD, and CMV viremia (p= 0.001). The patients without CMV antigenemia had a higher incidence of mortality at first 100-day, and 365-day in allogeneic transplant group (p= 0.022, p= 0.024, respectively). The 5-year overall survival (OS) rate was 61% in the viremia group, and 62% in the non-viremia group. There was no statistically significant difference between the two groups in terms of 5-year OS (p= 0.551). In patients receiving a lower dose of 900 mg/day valganciclovir treatment due to viremia, CMV disease did not develop and no adverse effect that required the drug to be discontinued was observed. Conclusion:The results conducted that development of GVHD was associated with CMV viremia. Early and late mortality rate were higher in the patients without CMV antigenemia. However; CMV reactivation had no impact on patients' survival post allogeneic and autologous HSCT. Also, this was the first study that conducted preemptive treatment approach in the CMV viremia using a lower dose valganciclovir is safe and effective in HSCT.

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Haploidentical and matched unrelated donor allogeneic hematopoietic stem cell transplantation offer similar survival outcomes for acute leukemia

Wang,

Lai,

Chen

et al. 2024

Cancer Reports

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BackgroundHaploidentical hematopoietic stem cell transplantation (haplo‐HSCT) has emerged as an effective approach for acute leukemia, primarily due to the inherent difficulty in finding human leukocyte antigen‐matched unrelated donors (MUD). Nevertheless, it remains uncertain whether haplo‐HSCT and MUD‐HSCT can provide comparable outcomes in patients with acute leukemia.AimsThis study aimed to assess the overall survival (OS) and leukemia‐free survival (LFS) outcomes between the MUD‐HSCT and haplo‐HSCT groups.Methods and resultsThis retrospective analysis encompassed adult patients with acute leukemia undergoing the initial allo‐HSCT. Among these 85 patients, we stratified 33 patients into the MUD‐HSCT group and 52 to the haplo‐HSCT group. The primary outcomes were OS and LFS. The median OS was not reached in the haplo‐HSCT group, while it reached 29.8 months in patients undergoing MUD‐HSCT (p = .211). Likewise, the median LFS periods were 52.6 months in the haplo‐HSCT group and 12.7 months in the MUD‐HSCT group (p = .212). Importantly, neither the OS nor LFS showed substantial differences between the MUD‐HSCT and haplo‐HSCT groups. Furthermore, univariate analyses revealed that haplo‐HSCT did not demonstrate a significantly higher risk of worse LFS (hazard ratio [HR], 0.69; 95% confidence interval [CI], 0.38–1.25; p = .216) or OS (HR, 0.67; 95% CI, 0.36–1.26; p = .214) than MUD‐HSCT. Notably, a high European Group for Blood and Marrow Transplantation risk score (HR, 1.44; 95% CI, 1.10–1.87; p = .007) and non‐complete remission (HR, 2.48; 95% CI, 1.17–5.23; p = .017) were significantly correlated with worse OS.ConclusionHaplo‐HSCT may serve as an alternative to MUD‐HSCT for the treatment of acute leukemia, offering similar survival outcomes.

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Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

Cited by 15 publications

References 23 publications

Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia

Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia

Cytomegalovirus Reactivation in Hematopoietic Stem cell Transplantation managed by Preemptive Treatment with lower dose Valganciclovir

Haploidentical and matched unrelated donor allogeneic hematopoietic stem cell transplantation offer similar survival outcomes for acute leukemia

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