title: Prognostic impact of viral reactivations in acute myeloid leukemia patients undergoing allogeneic stem cell transplantation in first complete response.
abstract: Cytomegalovirus (CMV) serological status of donor and recipient as well as CMV reactivation have been associated with a lower risk of relapse in acute myeloid leukemia (AML) patients after allogeneic stem cell transplantation (alloSCT). Since immunosuppression following transplant allows resurgence of many other viruses, we retrospectively evaluated the impact of viral reactivations on relapse and survival in a cohort of 136 AML patients undergoing alloSCT in first remission from sibling (68%) or unrelated (32%) donors. Myeloablative and reduced-intensity conditioning regimen were given to 71 and 65 patients, respectively. Including CMV reactivations, at least 1 viral reactivation was recorded in 76 patients. Viral reactivations were associated with a lower risk of relapse (adjusted HR 0.14; 95% CI 0.07-0.30; P < 0.01), better disease-free survival (aHR 0.29; 95% CI 0.16-0.54; P < 0.01) but higher non relapse mortality. This translated into a better overall survival (aHR 0.44; 95%CI 0.25-0.77; P < 0.01) in patients who experienced viral reactivation. Thus, viral reactivations, including but not limited to CMV reactivation, are associated with a better outcome particularly with regard to the risk of relapse in AML patients undergoing alloSCT. New guidelines regarding the choice of donor according to the CMV serostatus are needed.
authors.affiliation: Service d'Hématologie, Institut Universitaire du Cancer de Toulouse Oncopole Université Toulouse III Paul Sabatier Service d'Epidémiologie, Centre Hospitalier Universitaire de Toulouse UMR 1027, INSERM-Université de Toulouse III Service d'Immunologie, Centre Hospitalier de Toulouse Rangueil Service de Virologie, Centre Hospitalier de Toulouse Purpan UMR 1037, Centre de Recherche en Cancérologie de Toulouse, INSERM-Université de Toulouse III, Toulouse, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Guenounou
authors.forename: Cécile
authors.initials: C
authors.lastname: Borel
authors.forename: Emilie
authors.initials: E
authors.lastname: Bérard
authors.forename: Edwige
authors.initials: E
authors.lastname: Yon
authors.forename: Marylise
authors.initials: M
authors.lastname: Fort
authors.forename: Catherine
authors.initials: C
authors.lastname: Mengelle
authors.forename: Sarah
authors.initials: S
authors.lastname: Bertoli
authors.forename: Audrey
authors.initials: A
authors.lastname: Sarry
authors.forename: Suzanne
authors.initials: S
authors.lastname: Tavitian
authors.forename: Françoise
authors.initials: F
authors.lastname: Huguet
authors.forename: Michel
authors.initials: M
authors.lastname: Attal
authors.forename: Christian
authors.initials: C
authors.lastname: Récher
authors.forename: Anne
authors.initials: A
authors.lastname: Huynh
mesh_terms: D000212:Acyclovir / Q000627:therapeutic use; D000293:Adolescent; D000328:Adult; D000368:Aged; D000998:Antiviral Agents / Q000627:therapeutic use; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015470:Leukemia, Myeloid, Acute / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012008:Recurrence; D012074:Remission Induction; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous
chemical_list: D000998:Antiviral Agents; D015774:Ganciclovir; D000212:Acyclovir