title: Impact of early CMV reactivation in cord blood stem cell recipients in the current era.
abstract: Several studies have reported an association between CMV reactivation and a decreased incidence of relapse for AML after adult donor allogeneic hematopoietic cell transplantation (HCT). Limited data, however, are available on the impact of CMV reactivation on relapse after cord blood (CB) stem cell transplantation. The unique combination of higher incidence of CMV reactivation in the seropositive recipient and lower incidence of graft versus host disease (GvHD) in CB HCT permits a valuable design to analyze the impact of CMV reactivation. Data from 1684 patients transplanted with CB between 2003 and 2010 for AML and ALL were analyzed. The median time to CMV reactivation was 34 days (range: 2-287). CMV reactivation and positive CMV serology were associated with increased non-relapse mortality (NRM) among both AML and ALL CB recipients (reactivation, AML: relative risk (RR) 1.41 (1.07-1.85); ALL: 1.60 (1.14-2.23); Serology, AML: RR 1.39 (1.05-1.85), ALL: RR 1.61 (1.18-2.19)). For patients with ALL, but not those with AML, this yielded inferior overall survival (P<0.005). Risk of relapse was not influenced by CMV reactivation or positive CMV serostatus for either disease.
authors.affiliation: Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Ramanathan
authors.affiliation: Sainte Justine Hospital, University of Montreal, Montreal, Canada.
authors.forename: P
authors.initials: P
authors.lastname: Teira
authors.affiliation: Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
authors.forename: M
authors.initials: M
authors.lastname: Battiwalla
authors.affiliation: Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
authors.forename: J
authors.initials: J
authors.lastname: Barrett
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.|Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: K W
authors.initials: KW
authors.lastname: Ahn
authors.affiliation: Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: M
authors.initials: M
authors.lastname: Chen
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
authors.forename: J
authors.initials: J
authors.lastname: Green
authors.affiliation: Medical Director, Cleveland Cord Blood Center, Cleveland, OH, USA.
authors.forename: M
authors.initials: M
authors.lastname: Laughlin
authors.affiliation: Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
authors.forename: H M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK.
authors.forename: D
authors.initials: D
authors.lastname: Marks
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
authors.forename: A
authors.initials: A
authors.lastname: Saad
authors.affiliation: Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Seftel
authors.affiliation: CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
authors.forename: W
authors.initials: W
authors.lastname: Saber
authors.affiliation: Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
authors.forename: B
authors.initials: B
authors.lastname: Savani
authors.affiliation: Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
authors.forename: E K
authors.initials: EK
authors.lastname: Waller
authors.affiliation: Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.
authors.forename: J
authors.initials: J
authors.lastname: Wingard
authors.affiliation: Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA.
authors.forename: J J
authors.initials: JJ
authors.lastname: Auletta
authors.affiliation: Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands.
authors.forename: C A
authors.initials: CA
authors.lastname: Lindemans
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
authors.forename: M
authors.initials: M
authors.lastname: Boeckh
authors.affiliation: Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: M L
authors.initials: ML
authors.lastname: Riches
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects / Q000401:mortality; D003587:Cytomegalovirus / Q000502:physiology*; D005260:Female; D006086:Graft vs Host Disease; D006801:Humans; D007223:Infant; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D014775:Virus Activation; D055815:Young Adult