TY - JOUR
T1 - Posttransplant cyclophosphamide is associated with increased cytomegalovirus infection
T2 - a CIBMTR analysis
AU - CIBMTR Infection and Immune Reconstitution Working Committee
AU - Goldsmith, Scott R.
AU - Abid, Muhammad Bilal
AU - Auletta, Jeffery J.
AU - Bashey, Asad
AU - Beitinjaneh, Amer
AU - Castillo, Paul
AU - Chemaly, Roy F.
AU - Chen, Min
AU - Ciurea, Stefan
AU - Dandoy, Christopher E.
AU - Díaz, Miguel Ángel
AU - Fuchs, Ephraim
AU - Ganguly, Siddhartha
AU - Kanakry, Christopher G.
AU - Kanakry, Jennifer A.
AU - Kim, Soyoung
AU - Komanduri, Krishna V.
AU - Krem, Maxwell M.
AU - Lazarus, Hillard M.
AU - Liu, Hongtao
AU - Ljungman, Per
AU - Masiarz, Richard
AU - Mulroney, Carolyn
AU - Nathan, Sunita
AU - Nishihori, Taiga
AU - Page, Kristin M.
AU - Perales, Miguel Angel
AU - Taplitz, Randy
AU - Romee, Rizwan
AU - Riches, Marcie
N1 - Publisher Copyright:
© 2021 American Society of Hematology
PY - 2021/6/10
Y1 - 2021/6/10
N2 - Prior studies suggest increased cytomegalovirus (CMV) infection after haploidentical donor transplantation with posttransplant cyclophosphamide (HaploCy). The role of allograft source and posttransplant cyclophosphamide (PTCy) in CMV infection is unclear. We analyzed the effect of graft source and PTCy on incidence of CMV infection, and effects of serostatus and CMV infection on transplant outcomes. We examined patients reported to the Center for International Blood and Marrow Transplantation Research between 2012 and 2017 who had received HaploCy (n = 757), matched related (Sib) with PTCy (SibCy, n = 403), or Sib with calcineurin inhibitor-based prophylaxis (SibCNI, n = 1605). Cumulative incidences of CMV infection by day 180 were 42%, 37%, and 23%, respectively (P < .001). CMV disease was statistically comparable. CMV infection risk was highest for CMV-seropositive recipients (R+), but significantly higher in PTCy recipients regardless of donor (HaploCy [n = 545]: hazard ratio [HR], 50.3; SibCy [n = 279]: HR, 47.7; SibCNI [n = 1065]: HR, 24.4; P < .001). D+/R− patients also had increased risk for CMV infection. Among R+ or those developing CMV infection, HaploCy had worse overall survival and nonrelapse mortality. Relapse was unaffected by CMV infection or serostatus. PTCy was associated with lower chronic graft-versus-host disease (GVHD) overall, but CMV infection in PTCy recipients was associated with higher chronic GVHD (P = .006). PTCy, regardless of donor, is associated with higher incidence of CMV infection, augmenting the risk of seropositivity. Additionally, CMV infection may negate the chronic GVHD protection of PTCy. This study supports aggressive prevention strategies in all receiving PTCy.
AB - Prior studies suggest increased cytomegalovirus (CMV) infection after haploidentical donor transplantation with posttransplant cyclophosphamide (HaploCy). The role of allograft source and posttransplant cyclophosphamide (PTCy) in CMV infection is unclear. We analyzed the effect of graft source and PTCy on incidence of CMV infection, and effects of serostatus and CMV infection on transplant outcomes. We examined patients reported to the Center for International Blood and Marrow Transplantation Research between 2012 and 2017 who had received HaploCy (n = 757), matched related (Sib) with PTCy (SibCy, n = 403), or Sib with calcineurin inhibitor-based prophylaxis (SibCNI, n = 1605). Cumulative incidences of CMV infection by day 180 were 42%, 37%, and 23%, respectively (P < .001). CMV disease was statistically comparable. CMV infection risk was highest for CMV-seropositive recipients (R+), but significantly higher in PTCy recipients regardless of donor (HaploCy [n = 545]: hazard ratio [HR], 50.3; SibCy [n = 279]: HR, 47.7; SibCNI [n = 1065]: HR, 24.4; P < .001). D+/R− patients also had increased risk for CMV infection. Among R+ or those developing CMV infection, HaploCy had worse overall survival and nonrelapse mortality. Relapse was unaffected by CMV infection or serostatus. PTCy was associated with lower chronic graft-versus-host disease (GVHD) overall, but CMV infection in PTCy recipients was associated with higher chronic GVHD (P = .006). PTCy, regardless of donor, is associated with higher incidence of CMV infection, augmenting the risk of seropositivity. Additionally, CMV infection may negate the chronic GVHD protection of PTCy. This study supports aggressive prevention strategies in all receiving PTCy.
KW - CIMBTR
KW - CMV
KW - MARROW AND STEM CELL TRANSPLANTATION
KW - haploidentical
KW - organ specific toxicity: infectious
KW - outcomes
KW - posttransplant cyclophosphamide
UR - http://www.scopus.com/inward/record.url?scp=85105959173&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85105959173&partnerID=8YFLogxK
U2 - 10.1182/blood.2020009362
DO - 10.1182/blood.2020009362
M3 - Article
C2 - 33657221
AN - SCOPUS:85105959173
SN - 0006-4971
VL - 137
SP - 3291
EP - 3305
JO - Blood
JF - Blood
IS - 23
ER -