title: Protective effect of cytomegalovirus reactivation on relapse after allogeneic hematopoietic cell transplantation in acute myeloid leukemia patients is influenced by conditioning regimen.
abstract: Cytomegalovirus (CMV) reactivation after allogeneic hematopoietic cell transplant (allo-HCT) has been associated with a reduced risk of relapse in patients with acute myeloid leukemia (AML). However, the influence of the conditioning regimen on this protective effect of CMV reactivation after allo-HCT is relatively unexplored. To address this, we evaluated the risk of relapse in 264 AML patients who received T cell-replete, 6/6 HLA matched sibling or 10/10 HLA matched unrelated donor transplantation at a single institution between 2006 and 2011. Of these 264 patients, 206 received myeloablative (MA) and 58 received reduced-intensity conditioning (RIC) regimens. CMV reactivation was observed in 88 patients with MA conditioning and 37 patients with RIC. At a median follow-up of 299 days, CMV reactivation was associated with significantly lower risk of relapse in patients who received MA conditioning both in univariate (P = .01) and multivariate analyses (hazard ratio, .5246; P = .006); however, CMV reactivation did not significantly affect the risk of relapse in our RIC cohort. These results confirm the protective effect of CMV reactivation on relapse in AML patients after allo-HCT reported by previous studies but suggest this protective effect of CMV reactivation on relapse is influenced by the conditioning regimen used with the transplant.
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Shivaprasad
authors.initials: S
authors.lastname: Manjappa
authors.affiliation: Division of Hospital Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Pavan Kumar
authors.initials: PK
authors.lastname: Bhamidipati
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Keith E
authors.initials: KE
authors.lastname: Stokerl-Goldstein
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: John F
authors.initials: JF
authors.lastname: DiPersio
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Geoffrey L
authors.initials: GL
authors.lastname: Uy
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Peter
authors.initials: P
authors.lastname: Westervelt
authors.affiliation: Division of Biostatistics, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Jingxia
authors.initials: J
authors.lastname: Liu
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Schroeder
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Ravi
authors.initials: R
authors.lastname: Vij
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Camille N
authors.initials: CN
authors.lastname: Abboud
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Todd A
authors.initials: TA
authors.lastname: Fehniger
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Amanda F
authors.initials: AF
authors.lastname: Cashen
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Iskra
authors.initials: I
authors.lastname: Pusic
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Meagan
authors.initials: M
authors.lastname: Jacoby
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Srinidhi J
authors.initials: SJ
authors.lastname: Meera
authors.affiliation: Section of Bone Marrow Transplant and Leukemia, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri. Electronic address: rromee@dom.wustl.edu.
authors.forename: Rizwan
authors.initials: R
authors.lastname: Romee
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003587:Cytomegalovirus / Q000502:physiology*; D005260:Female; D020544:Graft vs Leukemia Effect; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000276:immunology / Q000473:pathology / Q000628:therapy* / Q000821:virology; D008212:Lymphocyte Depletion; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019653:Myeloablative Agonists / Q000627:therapeutic use*; D012306:Risk; D055502:Secondary Prevention; D035781:Siblings; D013601:T-Lymphocytes / Q000187:drug effects / Q000276:immunology / Q000473:pathology; D019172:Transplantation Conditioning / Q000379:methods*; D014184:Transplantation, Homologous; D061349:Unrelated Donors; D014775:Virus Activation / Q000187:drug effects*
chemical_list: D006680:HLA Antigens; D019653:Myeloablative Agonists
keywords: Acute myeloid leukemia; Allogeneic hematopoietic cell transplantation; CMV; Myeloablative; Reduced intensity; Relapse