title: CMV reactivation after allogeneic HCT and relapse risk: evidence for early protection in acute myeloid leukemia.
abstract: The association between cytomegalovirus (CMV) reactivation and relapse was evaluated in a large cohort of patients with acute myeloid leukemia (AML) (n = 761), acute lymphoblastic leukemia (ALL) (n = 322), chronic myeloid leukemia (CML) (n = 646), lymphoma (n = 254), and myelodysplastic syndrome (MDS) (n = 371) who underwent allogeneic hematopoietic cell transplantation (HCT) between 1995 and 2005. In multivariable models, CMV pp65 antigenemia was associated with a decreased risk of relapse by day 100 among patients with AML (hazard ratio [HR] = 0.56; 95% confidence interval [CI], 0.3-0.9) but not in patients with ALL, lymphoma, CML, or MDS. The effect appeared to be independent of CMV viral load, acute graft-versus-host disease, or ganciclovir-associated neutropenia. At 1 year after HCT, early CMV reactivation was associated with reduced risk of relapse in all patients, but this did not reach significance for any disease subgroup. Furthermore, CMV reactivation was associated with increased nonrelapse mortality (HR = 1.31; 95% CI, 1.1-1.6) and no difference in overall mortality (HR = 1.05; 95% CI, 0.9-1.3). This report demonstrates a modest reduction in early relapse risk after HCT associated with CMV reactivation in a large cohort of patients without a benefit in overall survival.
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA. mlgreen@fhcrc.org
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Green
authors.forename: Wendy M
authors.initials: WM
authors.lastname: Leisenring
authors.forename: Hu
authors.initials: H
authors.lastname: Xie
authors.forename: Roland B
authors.initials: RB
authors.lastname: Walter
authors.forename: Marco
authors.initials: M
authors.lastname: Mielcarek
authors.forename: Brenda M
authors.initials: BM
authors.lastname: Sandmaier
authors.forename: Stanley R
authors.initials: SR
authors.lastname: Riddell
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000150:complications / Q000517:prevention & control / Q000821:virology; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000517:prevention & control* / Q000821:virology; D008223:Lymphoma / Q000150:complications / Q000517:prevention & control / Q000821:virology; D008297:Male; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000517:prevention & control / Q000821:virology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000517:prevention & control* / Q000821:virology; D010750:Phosphoproteins / Q000097:blood / Q000276:immunology*; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000517:prevention & control / Q000821:virology; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014763:Viral Matrix Proteins / Q000097:blood / Q000276:immunology*; D014775:Virus Activation; D055815:Young Adult
chemical_list: D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa