Patient cytomegalovirus seropositivity with or without reactivation is the most important prognostic factor for survival and treatment-related mortality in stem cell transplantation from unrelated donors using pretransplant in vivo T-cell depletion with anti-thymocyte globulin.
We evaluated the cytomegalovirus (CMV) serostatus as a risk factor for survival and treatment-related mortality (TRM) in 125 patients allografted from an unrelated donor between 1994 and 1999. All patients received pretransplant in vivo T-cell depletion using rabbit anti-thymocyte globulin (ATG). Only one patient had primary graft failure and severe grade III/IV graft-versus-host disease occurred in 14% of the patients. The overall survival (OS) at 3 years was 70% for CMV-negative patients (n = 76) and 29% in the seropositive cohort (n = 49) (P > 0.001). In multivariate analyses, CMV seropositivity remained an independent negative prognostic factor for OS (RR: 2.1; CI: 1.2-3.8; P = 0.014), apart from age > 20 years (RR: 2.74; CI: 1.2-3.8; P = 0.004) and late leucocyte engraftment (RR: 2.4; CI: 1.2-4.9; P = 0.015). The TRM for all patients was 27%. Despite monitoring for CMV antigenaemia and preemptive therapy with ganciclovir when reactivation occurred, seropositive patients had a three times higher risk of fatal treatment-related complications than seronegative patients. In multivariate analyses, CMV seropositivity remained the strongest independent negative factor for TRM (RR: 5.3; CI: 1.9-14.6; P = 0.002), followed by age > 20 years (RR: 4.8; CI: 1.3-18.1; P = 0.02) and delayed leucocyte engraftment (RR: 3.6; CI: 1.2-11; P = 0.02). The TRM was identical in seropositive patients with (n = 27) or without (n = 22) CMV reactivation (44% versus 50%). We conclude that CMV seropositivity, despite preemptive ganciclovir therapy and even without reactivation, is a major negative prognostic factor for survival as well as for TRM in unrelated stem cell transplantation using pretransplant in vivo T-cell depletion with ATG.
Kröger
N
N
Bone Marrow Transplantation, University Hospital Hamburg, Department of Bone Marrow Transplantation, Pavlow University, St Petersburg, Russia. nkroeger@uke.uni-hamburg.de
Zabelina
T
T
Krüger
W
W
Renges
H
H
Stute
N
N
Schrum
J
J
Kabisch
H
H
Schafhausen
P
P
Jaburg
N
N
Löliger
C
C
Schäfer
P
P
Hinke
A
A
Zander
A R
AR
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000961:Antilymphocyte Serum / Q000008:administration & dosage*; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000150:complications*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000401:mortality*; D006801:Humans; D007223:Infant; D007938:Leukemia / Q000628:therapy / Q000821:virology*; D007951:Leukemia, Myeloid / Q000628:therapy / Q000821:virology; D015465:Leukemia, Myeloid, Accelerated Phase / Q000628:therapy / Q000821:virology; D015466:Leukemia, Myeloid, Chronic-Phase / Q000628:therapy / Q000821:virology; D015479:Leukemia, Myelomonocytic, Acute / Q000628:therapy / Q000821:virology; D008223:Lymphoma / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000628:therapy / Q000821:virology; D015999:Multivariate Analysis; D009190:Myelodysplastic Syndromes / Q000628:therapy / Q000821:virology; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000628:therapy / Q000821:virology; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous
D000961:Antilymphocyte Serum