CMV reactivation after allogeneic HCT and relapse risk: evidence for early protection in acute myeloid leukemia.

Publication Type:

Journal Article

Source:

Blood, Volume 122, Issue 7, p.1316-1324 (2013)

Keywords:

2013, Center-Authored Paper, Clinical Research Division, Collaborative Data Services Core Facility, June 2013, Research Trials Office Core Facility - Biostatistics Service, Vaccine and Infectious Disease Division

Abstract:

The association between CMV reactivation and relapse was evaluated in a large cohort of patients with acute myeloid leukemia (AML) (n=761), acute lymphoblastic leukemia (ALL) (n=322), chronic myeloid leukemia (CML) (n=646), lymphoma (n=254), and myelodysplastic syndrome (MDS) (n=371) who underwent allogeneic hematopoietic cell transplantation (HCT) between 1995 and 2005. In multivariable models, CMV pp65 antigenemia was associated with a decreased risk of relapse by day 100 among patients with AML (HR 0.56, 95%CI 0.3-0.9), but not in patients with ALL, lymphoma, CML or MDS. The effect appeared to be independent of CMV viral load, acute graft versus host disease or ganciclovir-associated neutropenia. At 1 year after HCT, early CMV reactivation was associated with reduced risk of relapse in all patients but this did not reach significance for any disease subgroup. Furthermore, CMV reactivation was associated with increased non-relapse mortality (HR 1.31, 95% CI 1.1-1.6) and no difference in overall mortality (HR 1.05, 95% CI 0.9-1.3). This report demonstrates a modest reduction in early relapse risk after HCT associated with CMV reactivation in a large cohort of patients, without a benefit in overall survival.