title: Early CMV replication and subsequent chronic GVHD have a significant anti-leukemic effect after allogeneic HSCT in acute myeloid leukemia.
abstract: Early cytomegalovirus (CMV) replication (eCMV) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been suggested as an independent factor that reduces leukemia relapse risk. We retrospectively analyzed 74 patients with acute myeloid leukemia (AML) who underwent allo-HSCT between August 2006 and September 2012. All recipients were CMV seropositive. In 52 patients, eCMV occurred at a median of 35 days (range, 11-92) after allo-HSCT. Univariate analysis revealed that the factors associated with a reduction in the 5-year cumulative incidence of relapse (CIR) included the first complete remission status at allo-HSCT, non-adverse cytogenetics and molecular abnormalities, pre-transplant serum ferritin level <1,400 mg/dL, chronic graft-versus-host disease (cGVHD), and eCMV. In sub-group analysis, according to the existence of eCMV and cGVHD, those with both eCMV and cGVHD showed the lowest 5-year CIR (P < 0.003). Patients with both eCMV and cGVHD had the best outcome for leukemia-free survival (LFS) (P < 0.001) and OS (P < 0.001). In the CMV-seropositive population, the presence of eCMV in combination with cGVHD had a significant positive effect on LFS and OS after allo-HSCT. When eCMV preceded cGVHD, the relapse rate after allo-HSCT was significantly reduced in patients with AML. Therefore, we suggest that it is critical to have an immunological understanding of the graft-versus-leukemia effect in this setting.
authors.affiliation: Division of Hematology, Department of Internal Medicine, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, Seoul, 120-751, South Korea.
authors.forename: Ji Eun
authors.initials: JE
authors.lastname: Jang
authors.forename: Soo Jeong
authors.initials: SJ
authors.lastname: Kim
authors.forename: June-Won
authors.initials: JW
authors.lastname: Cheong
authors.forename: Shin Young
authors.initials: SY
authors.lastname: Hyun
authors.forename: Yun Deok
authors.initials: YD
authors.lastname: Kim
authors.forename: Yu Ri
authors.initials: YR
authors.lastname: Kim
authors.forename: Jin Seok
authors.initials: JS
authors.lastname: Kim
authors.forename: Yoo Hong
authors.initials: YH
authors.lastname: Min
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D003587:Cytomegalovirus / Q000276:immunology* / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000097:blood / Q000276:immunology* / Q000821:virology; D005260:Female; D005500:Follow-Up Studies; D006086:Graft vs Host Disease / Q000209:etiology / Q000276:immunology* / Q000821:virology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D054884:Host-Pathogen Interactions / Q000276:immunology; D006801:Humans; D053208:Kaplan-Meier Estimate; D007951:Leukemia, Myeloid / Q000276:immunology* / Q000628:therapy / Q000821:virology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000276:immunology / Q000821:virology; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D013997:Time Factors; D014184:Transplantation, Homologous; D014779:Virus Replication / Q000276:immunology*; D055815:Young Adult