title: Early cytomegalovirus reactivation remains associated with increased transplant-related mortality in the current era: a CIBMTR analysis.
abstract: Single-center studies have reported an association between early (before day 100) cytomegalovirus (CMV) reactivation and decreased incidence of relapse for acute myeloid leukemia (AML) following allogeneic hematopoietic cell transplantation. To substantiate these preliminary findings, the Center for International Blood and Marrow Transplant Research (CIBMTR) Database was interrogated to analyze the impact of CMV reactivation on hematologic disease relapse in the current era. Data from 9469 patients transplanted with bone marrow or peripheral blood between 2003 and 2010 were analyzed according to 4 disease categories: AML (n = 5310); acute lymphoblastic leukemia (ALL, n = 1883); chronic myeloid leukemia (CML, n = 1079); and myelodysplastic syndrome (MDS, n = 1197). Median time to initial CMV reactivation was 41 days (range, 1-362 days). CMV reactivation had no preventive effect on hematologic disease relapse irrespective of diagnosis. Moreover, CMV reactivation was associated with higher nonrelapse mortality [relative risk [RR] among disease categories ranged from 1.61 to 1.95 and P values from .0002 to <.0001; 95% confidence interval [CI], 1.14-2.61). As a result, CMV reactivation was associated with lower overall survival for AML (RR = 1.27; 95% CI, 1.17-1.38; P <.0001), ALL (RR = 1.46; 95% CI, 1.25-1.71; P <.0001), CML (RR = 1.49; 95% CI, 1.19-1.88; P = .0005), and MDS (RR = 1.31; 95% CI, 1.09-1.57; P = .003). In conclusion, CMV reactivation continues to remain a risk factor for poor posttransplant outcomes and does not seem to confer protection against hematologic disease relapse.
authors.affiliation: Sainte Justine Hospital, University of Montreal, Montreal, Quebec, Canada;
authors.forename: Pierre
authors.initials: P
authors.lastname: Teira
authors.affiliation: Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD;
authors.forename: Minoo
authors.initials: M
authors.lastname: Battiwalla
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA;
authors.forename: Muthalagu
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Hematology Branch, National Heart, Lung, and Blood Institute, Bethesda, MD;
authors.forename: A John
authors.initials: AJ
authors.lastname: Barrett
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, and Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI;
authors.forename: Kwang Woo
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, and.
authors.forename: Min
authors.initials: M
authors.lastname: Chen
authors.affiliation: Division of Infectious Disease and International Medicine, Department of Medicine, University of Minnesota, Minneapolis, MN;
authors.forename: Jaime S
authors.initials: JS
authors.lastname: Green
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL;
authors.forename: Ayman
authors.initials: A
authors.lastname: Saad
authors.affiliation: Center for Hematologic Oncology, Dana-Farber Cancer Institute, Boston, MA;
authors.forename: Joseph H
authors.initials: JH
authors.lastname: Antin
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN;
authors.forename: Bipin N
authors.initials: BN
authors.lastname: Savani
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH;
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada;
authors.forename: Matthew
authors.initials: M
authors.lastname: Seftel
authors.affiliation: Center for International Blood and Marrow Transplant Research, Department of Medicine, and.
authors.forename: Wael
authors.initials: W
authors.lastname: Saber
authors.affiliation: Pediatric Bone Marrow Transplant, University Hospitals Bristol National Health Service Trust, Bristol, United Kingdom;
authors.forename: David
authors.initials: D
authors.lastname: Marks
authors.affiliation: Department of Oncology, King Faisal Specialist Hospital Center & Research, Ridayh, Saudi Arabia;
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Aljurf
authors.affiliation: Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL;
authors.forename: Maxim
authors.initials: M
authors.lastname: Norkin
authors.affiliation: Division of Hematology/Oncology, University Florida College of Medicine, Gainesville, FL;
authors.forename: John R
authors.initials: JR
authors.lastname: Wingard
authors.affiliation: Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, The Netherlands;
authors.forename: Caroline A
authors.initials: CA
authors.lastname: Lindemans
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA;
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
authors.affiliation: Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC; and.
authors.forename: Marcie L
authors.initials: ML
authors.lastname: Riches
authors.affiliation: Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH.
authors.forename: Jeffery J
authors.initials: JJ
authors.lastname: Auletta
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D064591:Allografts; D000914:Antibodies, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000276:immunology / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000188:drug therapy / Q000821:virology*; D016208:Databases, Factual; D018572:Disease-Free Survival; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology / Q000401:mortality; D006801:Humans; D007223:Infant; D053208:Kaplan-Meier Estimate; D007938:Leukemia / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000628:therapy*; D012008:Recurrence; D012042:Registries; D013997:Time Factors; D019172:Transplantation Conditioning / Q000009:adverse effects; D014775:Virus Activation; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D000998:Antiviral Agents