title: Donor T-cell chimerism and early post-transplant cytomegalovirus viremia in patients treated with myeloablative allogeneic hematopoietic stem cell transplant.
abstract: BACKGROUND
  Cytomegalovirus (CMV) is a common infection after myeloablative allogeneic hematopoietic stem cell transplant (M-alloHSCT). Achievement of complete donor T-cell chimerism (CDC-T) post transplant is a measure of immune reconstitution. We investigated the association between CDC-T post M-alloHSCT and the incidence of CMV viremia.
  
  
  METHODS
  We retrospectively reviewed all CMV and chimerism results of 47 patients for the first 6 months post M-alloHSCT. CDC-T was analyzed as a time-varying covariate for association with post M-alloHSCT CMV viremia.
  
  
  RESULTS
  CMV viremia occurred in 15 (32%) and CDC-T was achieved in 38 (81%) recipients within the first 6 months post M-alloHSCT. On univariable analysis, increased CMV viremia was seen among patients with CDC-T (hazard ratio 2.81 [P = 0.07, 95% confidence interval = 0.93-8.52]). A 30-day landmark analysis showed that the incidence of CMV viremia at 6 months (regardless of recipient CMV serostatus) was 50% among those who had achieved CDC-T by day 30, and 23% among those who had not (P = 0.06).
  
  
  CONCLUSIONS
  We conclude that shorter time to CDC-T may be associated with higher risk of CMV viremia. If confirmed in a larger cohort, this might be a marker for risk stratification in the management of CMV in this population.
authors.affiliation: Department of Medicine, Division of Infectious Diseases and Immunology at NYU Langone Medical Center, NYU School of Medicine, New York, New York, USA.
authors.forename: S
authors.initials: S
authors.lastname: Taimur
authors.forename: M
authors.initials: M
authors.lastname: Askar
authors.forename: R
authors.initials: R
authors.lastname: Sobecks
authors.forename: L
authors.initials: L
authors.lastname: Rybicki
authors.forename: I
authors.initials: I
authors.lastname: Warshawsky
authors.forename: S
authors.initials: S
authors.lastname: Mossad
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002066:Busulfan / Q000627:therapeutic use; D046528:Chimerism; D015331:Cohort Studies; D003520:Cyclophosphamide / Q000627:therapeutic use; D016572:Cyclosporine / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000276:immunology; D004247:DNA / Q000235:genetics*; D005260:Female; D006086:Graft vs Host Disease / Q000517:prevention & control; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D015994:Incidence; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use; D008875:Middle Aged; D009173:Mycophenolic Acid / Q000031:analogs & derivatives / Q000627:therapeutic use; D019653:Myeloablative Agonists / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013601:T-Lymphocytes; D016559:Tacrolimus / Q000627:therapeutic use; D013997:Time Factors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous; D014766:Viremia / Q000453:epidemiology* / Q000276:immunology; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D016572:Cyclosporine; D003520:Cyclophosphamide; D004247:DNA; D002066:Busulfan; D009173:Mycophenolic Acid; D016559:Tacrolimus; D008727:Methotrexate
keywords: chimerism; cytomegalovirus; hematopoietic stem cell transplant