title: Cytomegalovirus reactivation is associated with a lower rate of early relapse in myeloid malignancies independent of in-vivo T cell depletion strategy.
abstract: The association between cytomegalovirus (CMV) reactivation and relapse risk has not been evaluated in relation to T cell depletion strategies. We evaluated 93 patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) and analyzed the association between T cell depletion strategies with the cumulative incidence of relapse and CMV reactivation. A total of 33% of patients who received ATG vs. 34% who received alemtuzumab developed CMV reactivation. The cumulative incidence of relapse was 3% at 1year and 20% at 3 years in patients with CMV reactivation vs. 30% at 1year and 38% at 3 years in patients without CMV reactivation (p=0.02). When analyzed separately, this effect persisted in the myeloid, but not the lymphoid group. There was a numerical trend towards increased non-relapse mortality (NRM) in patients with CMV reactivation, especially in the myeloid group. The choice of T cell depleting agent and the rate of CMV reactivation were not associated with different overall survival (OS) rates. These results suggest that the choice of T cell depletion strategy may have similar effects on rates of CMV reactivation, disease relapse, and survival. Further studies examining these variables in patients not exposed to in-vivo T cell depleting agents may be of interest.
authors.affiliation: Department of Internal Medicine, University of Kentucky, Lexington, KY, United States; Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ, United States. Electronic address: hilal.talal@mayo.edu.
authors.forename: Talal
authors.initials: T
authors.lastname: Hilal
authors.affiliation: Biostatistics Shared Resource Facility, University of Kentucky Markey Cancer Center, Lexington, KY, United States.
authors.forename: Stacey
authors.initials: S
authors.lastname: Slone
authors.affiliation: Department of Internal Medicine, University of Kentucky, Lexington, KY, United States.
authors.forename: Shawn
authors.initials: S
authors.lastname: Peterson
authors.affiliation: Department of Internal Medicine, University of Kentucky, Lexington, KY, United States.
authors.forename: Charles
authors.initials: C
authors.lastname: Bodine
authors.affiliation: Division of Hematology and Blood and Marrow Transplant, University of Kentucky Markey Cancer Center, Lexington, KY, United States; Division of Hematology, University of Cincinnati Cancer Center, Cincinnati, OH, United States.
authors.forename: Zartash
authors.initials: Z
authors.lastname: Gul
mesh_terms: D003586:Cytomegalovirus Infections / Q000401:mortality / Q000821:virology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007951:Leukemia, Myeloid / Q000401:mortality / Q000473:pathology / Q000628:therapy / Q000821:virology*; D008212:Lymphocyte Depletion / Q000379:methods*; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate; D016896:Treatment Outcome; D014775:Virus Activation
keywords: Allogeneic HSCT; CMV reactivation; Cytomegalovirus; Leukemia; Stem cell transplant; T-cell depletion