title: Patients with refractory cytomegalovirus (CMV) infection following allogeneic haematopoietic stem cell transplantation are at high risk for CMV disease and non-relapse mortality.
abstract: Pre-emptive therapy is an effective approach for cytomegalovirus (CMV) control; however, refractory CMV still occurs in a considerable group of recipients after allogeneic haematopoietic stem cell transplantation (allo-HSCT). Until now, hardly any data have been available about the clinical characteristics and risk factors of refractory CMV, or its potential harmful impact on the clinical outcome following allo-HSCT. We studied transplant factors affecting refractory CMV in the 100 days after allo-HSCT, and the impact of refractory CMV on the risk of CMV disease and non-relapse mortality (NRM). We retrospectively studied 488 consecutive patients with CMV infection after allo-HSCT. Patients with refractory CMV in the 100 days after allo-HSCT had a higher incidence of CMV disease and NRM than those without refractory CMV (11.9% vs. 0.8% and 17.1% vs. 8.3%, respectively). Multivariate analysis showed that refractory CMV infection in the 100 days after allo-HSCT was an independent risk factor for CMV disease (hazard ratio (HR) 10.539, 95% CI 2.467-45.015, p 0.001), and that refractory CMV infection within 60-100 days after allo-HSCT was an independent risk factor for NRM (HR 8.435, 95% CI 1.511-47.099, p 0.015). Clinical factors impacting on the risk of refractory CMV infection included receiving transplants from human leukocyte antigen-mismatched family donors (HR 2.012, 95% CI 1.603-2.546, p <0.001) and acute graft-versus-host disease (HR 1.905, 95% CI 1.352-2.686, p <0.001). We conclude that patients with refractory CMV infection during the early stage after allo-HSCT are at high risk for both CMV disease and NRM.
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Liu
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: J
authors.initials: J
authors.lastname: Kong
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: Y J
authors.initials: YJ
authors.lastname: Chang
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: H
authors.initials: H
authors.lastname: Chen
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: Y H
authors.initials: YH
authors.lastname: Chen
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: W
authors.initials: W
authors.lastname: Han
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: C H
authors.initials: CH
authors.lastname: Yan
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: J Z
authors.initials: JZ
authors.lastname: Wang
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: F R
authors.initials: FR
authors.lastname: Wang
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Chen
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: X H
authors.initials: XH
authors.lastname: Zhang
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: L P
authors.initials: LP
authors.lastname: Xu
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China.
authors.forename: K Y
authors.initials: KY
authors.lastname: Liu
authors.affiliation: Peking University People's Hospital, Institute of Haematology, Beijing Key Laboratory of HSCT, Beijing, China. Electronic address: huangxiaojun@bjmu.edu.cn.
authors.forename: X J
authors.initials: XJ
authors.lastname: Huang
mesh_terms: D000293:Adolescent; D000328:Adult; D000942:Antigens, Bacterial / Q000097:blood; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000401:mortality* / Q000821:virology; D005260:Female; D006086:Graft vs Host Disease / Q000150:complications; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012189:Retrospective Studies; D012307:Risk Factors; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult
chemical_list: D000942:Antigens, Bacterial
keywords: Allogeneic haematopoietic stem cell transplantation; CMV disease; CMV infection; non-relapse mortality; refractory CMV