Impact of haploidentical hematopoietic cell transplantation conditioning intensity on the incidence and severity of post-transplantation viral infections

Comparison of Graft Acquisition and Early Direct Charges of Haploidentical Related Donor Transplantation versus Umbilical Cord Blood Transplantation

“…Considering that 45% of haplo-HCT recipients received bone marrow product with a higher mean graft acquisition charge ($37,526 versus $27,743 for the peripheral blood product), the cost saving could be even higher with the nearly universal adoption of peripheral blood haplo graft source (as far as graft costs are concerned). This cost saving in the long term, however, could be offset by higher risk of cytokines release syndrome and acute and chronic GVHD with peripheral blood haplo-HCT [35][36][37]. Of note, the inpatient and total (combined inpatient plus outpatient plus graft acquisition) charges in the first 100 days were similar between the 2 groups.…”

Incidence, features, and outcomes of cytomegalovirus DNAemia in unmanipulated haploidentical allogeneic hematopoietic stem cell transplantation with post‐transplantation cyclophosphamide

“…In our haplo‐HSCT cohort only recipient CMV seropositivity was associated with an increased risk of CMV DNAemia. Use of high‐dose corticosteroids for severe aGvHD, or conditioning regimens containing myeloablative doses of busulfan, or preceding HHV‐6 DNAemia have been reported to be associated with higher rates of CMV DNAemia in patients undergoing unmanipulated haplo‐HSCT.…”

“…In this retrospective multicenter study including a relatively large cohort of patients undergoing T-cell replete haplo-HSCT we found an overall cumulative incidence of CMV DNAemia of 63.9% by day 365 after transplantation, slightly higher than reported in other fairly comparable series (ranging from 30% to 55%). [12][13][14][18][19][20] Several non-mutually exclusive factors may account for this apparent discrepancy, including different follow-up lengths, the choice of immunosuppressive regimens for aGvHD prevention (ie, either including or not sirolimus 31 ), the blood specimen for CMV DNA surveillance (whole blood vs plasma) or the use of real-time PCRs for CMV DNA detection displaying distinct limits of detection. Regarding the latter issue, the cumulative incidence of CMV DNAemia was lower at HCUS (48.4%), where the Affigene Trender CMV PCR kit was used, than at the other participating centers (ranging from 56% to 78%), in which a more sensitive PCR assay (Abbott) was employed.…”

“…15,20 In our haplo-HSCT cohort only recipient CMV seropositivity was associated with an increased risk of CMV DNAemia. Use of highdose corticosteroids for severe aGvHD, 14 or conditioning regimens containing myeloablative doses of busulfan, 19 or preceding HHV-6…”

“…[1][2][3][4][5] Cytomegalovirus (CMV) remains a threat for allo-HSCT recipients despite the availability of effective strategies for the prevention of end-organ disease (ie, preemptive therapy), 6 since viral DNAemia itself may be detrimental in terms of survival. [7][8][9][10][11] Conflicting data have been published as to the incidence of CMV DNAemia and CMV disease in haplo-HSCT recipients, with some studies suggesting that this transplant modality harbors a significantly higher risk for both events when compared to HLA-matched related or unrelated allo-HSCTs, [12][13][14][15][16][17][18][19][20][21][22] yet this appeared not to have an impact on overall (OM) and non-relapse (NRM) mortality. 18,[23][24][25] In the current multicenter study, we estimated the incidence of CMV DNAemia, CMV disease OM, and NRM in haplo-allo-HSCT and compared to that in other transplant modalities.…”