title: A risk score for early cytomegalovirus reactivation after allogeneic stem cell transplantation identifies low-, intermediate-, and high-risk groups: reactivation risk is increased by graft-versus-host disease only in the intermediate-risk group.
abstract: BACKGROUND
  This retrospective study was aimed at establishing a clinical score to stratify the risk of cytomegalovirus (CMV) reactivation in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) in order to direct strategies for post-transplant CMV monitoring and therapy.
  
  
  METHODS
  In total, 335 adult patients undergoing HSCT were analyzed and divided into a training set (n = 235) and a validation set (n = 100). Logistic regression analysis on the training set identified recipient and donor CMV seropositivity, acute graft-versus-host disease (GVHD), and use of anti-thymocyte globulin or alemtuzumab as significant risk factors for CMV reactivation. Weighted scores were assigned to each factor. A weighted score (CMV scoring index [CSI]) was calculated for each patient using the scores of all risk factors except for GVHD. The index was collapsed into 3 risk groups - low risk (score of 0-2), intermediate risk (score of 3-5), and high risk (score of 6-7) - and reactivation rates were calculated. In the training set, CMV reactivation occurred in 5.8% in the low-risk group, 44.8% in the intermediate-risk group, and 67.7% in the high-risk group.
  
  
  RESULTS
  In patients with an intermediate CSI only, significantly higher reactivation rates were seen in the presence of corticosteroid treatment for GVHD (57.8% vs. 24.5%, P < 0.01). These findings were similar in the validation set with reactivation rates of 0% in the low-risk, 46% in the intermediate-risk, and 68.4% in the high-risk groups. As seen in the training set, the presence of GVHD was associated with higher CMV reactivation rates only in the intermediate-risk group (64% vs. 28% in the absence of GVHD, P = 0.02).
  
  
  CONCLUSIONS
  Identification of these 3 risk groups in association with the presence or absence of GVHD will help transplant units to make pre-transplant policy decisions about prophylactic, pre-emptive, or experimental CMV prevention strategies in groups of patients undergoing HSCT, as well as in those developing GVHD post transplant.
authors.affiliation: Department of Haematology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia.
authors.forename: B
authors.initials: B
authors.lastname: George
authors.forename: I H
authors.initials: IH
authors.lastname: Kerridge
authors.forename: N
authors.initials: N
authors.lastname: Gilroy
authors.forename: G
authors.initials: G
authors.lastname: Huang
authors.forename: M S
authors.initials: MS
authors.lastname: Hertzberg
authors.forename: K F
authors.initials: KF
authors.lastname: Bradstock
authors.forename: D J
authors.initials: DJ
authors.lastname: Gottlieb
mesh_terms: D003586:Cytomegalovirus Infections / Q000209:etiology / Q000276:immunology / Q000821:virology*; D006086:Graft vs Host Disease / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D012189:Retrospective Studies; D012307:Risk Factors; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014184:Transplantation, Homologous; D014775:Virus Activation / Q000276:immunology*
chemical_list: D007166:Immunosuppressive Agents