Survival benefit of asymptomatic cytomegalovirus reactivation after HLA-identical allogeneic peripheral blood stem cell transplantation.
BACKGROUND
Cytomegalovirus (CMV) reactivation (CMV-R) is associated with increased morbidity after allogeneic stem cell transplantation (SCT). However, after the introduction of ganciclovir preemptive therapy, CMV-R can be successfully controlled if the recipient's immunity recovers. Although many investigations have already focused on CMV-R as a risk factor, data related to the impact of asymptomatic CMV-R on transplant outcomes is scarce. Accordingly, the present study analyzed the differences in the transplant outcomes the immune reconstitution according to the CMV-R after allogeneic PBSCT.


METHODS
A total of 76 patients undergoing allogeneic peripheral blood stem cell transplantation (PBSCT) were included in the current study. The transplant outcomes and immune reconstitution after 3, 6, and 12 months were analyzed according to the occurrence of CMV-R in 33 patients.


RESULTS
The analysis revealed a favorable prognosis for the group with CMV-R compared to those without CMV-R: P = 0.0037 for OS, P = 0.0204 for NRM, and P = 0.05 for the risk of relapse. CMV-R was also found to correlate to the lymphoid reconstitution (P = 0.024). In multivariate analyses, CMV-R was found to be a favorable prognostic factor in terms of OS (P = 0.010, hazard ratio [HR] 2.948) and NRM (P = 0.05, HR 2.665), along with a higher transplant CD34 cell dose (P = 0.003 for OS, P = 0.002 for NRM), standard risk (P = 0.023 for OS), and acute GVHD grades 0-2 (P = 0.007 for NRM).


CONCLUSIONS
In a PBSCT setting, CMV-R did not seem to be a poor prognostic factor in terms of OS and NRM, possibly due to the accelerated lymphoid immune reconstitution associated with CMV-R.
Kim
Dong Hwan
DH
Department of Hematology/Oncology, Kyungpook National University Hospital, Jung-Gu, Daegu, Korea.
Won
Dong Il
DI
Lee
Nan Young
NY
Sohn
Sang Kyun
SK
Baek
Jin Ho
JH
Kim
Jong Gwang
JG
Suh
Jang Soo
JS
Lee
Kyu Bo
KB
D000293:Adolescent; D000328:Adult; D002454:Cell Differentiation; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000276:immunology* / Q000821:virology*; D005260:Female; D006680:HLA Antigens / Q000276:immunology*; D006801:Humans; D008214:Lymphocytes / Q000166:cytology / Q000276:immunology; D008297:Male; D008875:Middle Aged; D036102:Peripheral Blood Stem Cell Transplantation; D012307:Risk Factors; D015996:Survival Rate; D014184:Transplantation, Homologous; D016896:Treatment Outcome; D014775:Virus Activation / Q000502:physiology*
D006680:HLA Antigens