Cytomegalovirus reactivation in lymphoma and myeloma patients undergoing autologous peripheral blood stem cell transplantation

Massoud, Radwan; Assi, Rita; Fares, Elie-Jacques; Haffar, Basel; Charafeddine, Maya; Kreidieh, Nabila; Mahfouz, Rami; Kanj, Souha S.; Zakhem, Aline El; Kharfan‐Dabaja, Mohamed A.; Bazarbachi, Ali; Cheikh, Jean El

doi:10.1016/j.jcv.2017.08.006

Cited by 12 publications

(7 citation statements)

References 28 publications

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“…The present study analyzed the risk factors for late CMV reactivation after auto-SCT because late CMV reactivation was an independent predictor of poor survival after auto-SCT in our setting. According to a previous report, OS was significantly lower in patients with lymphoma with CMV reactivation than in those without CMV reactivation; however, no difference in OS was observed in patients with multiple myeloma [11]. These findings were partially comparable to our results that CMV reactivation was associated with favorable OS in patients with multiple myeloma but not in patients with lymphoma.…”

Section: Discussionsupporting

confidence: 88%

“…Moreover, symptomatic CMV reactivation or infection is rare in the auto-SCT setting 10 . However, the incidence of CMV reactivation is high in patients with lymphoma and multiple myeloma based on treatment and disease-associated characteristics 10 , 11 . Although CMV was found to cause life-threatening complications, such as pneumonia, in patients who underwent auto-SCT 12 , most studies were conducted before the introduction of novel chemotherapeutic drugs 10 .…”

Section: Introductionmentioning

confidence: 99%

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Prognostic outcomes of cytomegalovirus reactivation after autologous stem cell transplantation

Lee¹,

Jeon²,

Yu³

et al. 2023

Int. J. Med. Sci.

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Background: Cytomegalovirus (CMV) reactivation is a common complication in patients undergoing allogeneic stem cell transplantation. However, the incidence of CMV reactivation is low after autologous stem cell transplantation (auto-SCT), and the prognostic value of CMV reactivation remains controversial. Moreover, reports on late CMV reactivation after auto-SCT are limited. We aimed to analyze the association between CMV reactivation and survival outcomes and develop a predictive model for late CMV reactivation in patients undergoing auto-SCT. Methods: Data of 201 patients who underwent SCT at the Korea University Medical Center from 2007 to 2018 were collected. We analyzed prognostic factors for survival outcomes after auto-SCT and risk factors for late CMV reactivation using a receiver operating characteristic curve. Then, we developed a predictive risk model for late CMV reactivation based on results of the risk factor analysis. Results: Early CMV reactivation was significantly associated with better overall survival (OS) (hazard ratio [HR], 0.329; P = 0.045) in patients with multiple myeloma; however, no significant differences were observed in patients with lymphoma. For late CMV reactivation, a serum lactate dehydrogenase level greater than the upper limit of normal (HR, 2.251; P = 0.027) and late CMV reactivation (HR, 2.964; P = 0.047) were independent risk factors for poor OS, while lymphoma diagnosis (vs. multiple myeloma; HR, 0.389; P = 0.016) was an independent risk factor for good OS. In risk factor analysis for late CMV reactivation, T-cell lymphoma diagnosis (odds ratio [OR], 8.499; P = 0.029), ≥ two prior chemotherapies (OR, 8.995; P = 0.027), failure to achieve complete response (CR) after transplantation (OR, 7.124; P = 0.031), and early CMV reactivation (OR, 12.853; P = 0.007) were significantly associated with late CMV reactivation. To develop the predictive risk model for late CMV reactivation, a score (1 to 1.5) was assigned for each of the above-mentioned variables. The optimal cutoff value (1.75 points) was calculated using the receiver operating characteristic curve. The predictive risk model showed good discrimination, with an area under the curve of 0.872 (standard error, 0.062; P < 0.001). Conclusions: Late CMV reactivation was an independent risk factor for inferior OS, whereas early CMV reactivation was associated with better survival in patients with multiple myeloma. This risk prediction model could be helpful in identifying high-risk patients who require monitoring for late CMV reactivation and potentially benefit from prophylactic or preemptive therapy.

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Section: Discussionsupporting

confidence: 88%

Section: Introductionmentioning

confidence: 99%

Prognostic outcomes of cytomegalovirus reactivation after autologous stem cell transplantation

Lee¹,

Jeon²,

Yu³

et al. 2023

Int. J. Med. Sci.

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“…HDCT/auto-SCT can induce long-term remission in several hematological malignancies. A rapid reconstitution of immune cells including lymphocytes and NK-cells is associated with an improved PFS and overall survival (OS) 10 , 24 – 26 . Mounting evidence suggests an interrelation of immune cell proliferation, function, and metabolism.…”

Section: Discussionmentioning

confidence: 99%

The metabolic profile of reconstituting T-cells, NK-cells, and monocytes following autologous stem cell transplantation and its impact on outcome

Richter

Völkl

Mackensen

et al. 2022

Sci Rep

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Previous studies indicated a role of the reconstituting immune system for disease outcome upon high-dose chemotherapy (HDCT) and autologous stem cell transplantation (auto-SCT) in multiple myeloma (MM) and lymphoma patients. Since immune cell metabolism and function are closely interconnected, we used flow-cytometry techniques to analyze key components and functions of the metabolic machinery in reconstituting immune cells upon HDCT/auto-SCT. We observed increased proliferative activity and an upregulation of the glycolytic and fatty acid oxidation (FAO) machinery in immune cells during engraftment. Metabolic activation was more pronounced in T-cells of advanced differentiation stages, in CD56bright NK-cells, and CD14++CD16+ intermediate monocytes. Next, we investigated a potential correlation between the immune cells’ metabolic profile and early progression or relapse in lymphoma patients within the first twelve months following auto-SCT. Here, persistently increased metabolic parameters correlated with a rather poor disease course. Taken together, reconstituting immune cells display an upregulated bioenergetic machinery following auto-SCT. Interestingly, a persistently enhanced metabolic immune cell phenotype correlated with reduced PFS. However, it remains to be elucidated, if the clinical data can be confirmed within a larger set of patients and if residual malignant cells not detected by conventional means possibly caused the metabolic activation.

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“…The utility of CMV screening following auto-HSCT remains uncertain. While research has indicated a significant incidence of CMV reactivation occurring within the auto-HSCT population, 20,21 the benefit of routine screening and the risk of potential overtreatment are not established. 22 The use of acyclovir or a similar agent appears justified due to the risk of HSV reactivation following autologous HSCT.…”

Section: Discussionmentioning

confidence: 99%

Infection prophylaxis patterns following pediatric autologous hematopoietic stem cell transplantation: A survey of Pediatric Transplant and Cell Therapy Consortium centers

Falcon

Broglie

Phelan

et al. 2020

Pediatric Transplantation

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Auto-HSCT, also referred to as high-dose chemotherapy with hematopoietic stem cell rescue, is frequently incorporated into pediatric treatment protocols for neuroblastoma, malignant brain tumors, and relapsed lymphomas. Administration of myeloablative doses of chemotherapy is followed by autologous stem cell infusion in order to ensure hematopoietic recovery and to reduce the duration of pancytopenia. Use of auto-HSCT has improved outcomes for children with these malignancies, with high-risk neuroblastoma demonstrating the most marked improvement. Children with neuroblastoma undergoing a single auto-HSCT experienced improved 3-year EFS from 30% to 52%. 1 The addition of a second auto-HSCT transplant (tandem transplant) further improved outcomes with a reported 3-year EFS of 61%. 2

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Cytomegalovirus reactivation in lymphoma and myeloma patients undergoing autologous peripheral blood stem cell transplantation

Cited by 12 publications

References 28 publications

Prognostic outcomes of cytomegalovirus reactivation after autologous stem cell transplantation

Prognostic outcomes of cytomegalovirus reactivation after autologous stem cell transplantation

The metabolic profile of reconstituting T-cells, NK-cells, and monocytes following autologous stem cell transplantation and its impact on outcome

Infection prophylaxis patterns following pediatric autologous hematopoietic stem cell transplantation: A survey of Pediatric Transplant and Cell Therapy Consortium centers

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