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http://hdl.handle.net/11054/1766
Title: | Cytomegalovirus (CMV) management in allogeneic hematopoietic cell transplantation: Pre-transplant predictors of survival, reactivation, and spontaneous clearance. |
Author: | Lindsay, J. Othman, J. Kerridge, I. Fay, K. Stevenson, W. Arthur, C. Chen, S. Kong, David C. M. Pergam, S. Liu, C. Slavin, M. Greenwood, M. |
Issue Date: | 2021 |
Publication Title: | Transplant Infectious Disease |
Volume: | 23 |
Issue: | 3 |
Start Page: | e13548 |
Abstract: | Abstract Background: Cytomegalovirus (CMV) reactivation is a frequent complication after allogeneic hematopoietic cell transplant (alloHCT). Method: We analyzed 159 alloHCT recipients with 4409 quantitative CMV viral loads to determine pre-transplant predictors of CMV reactivation, clinically significant CMV infection (cs-CMVi, defined as CMV viral load >1000 IU/mL), CMV disease, kinetics of spontaneous clearance of CMV, and survival using a standardized pre-emptive therapy approach to identify at-risk groups to target prevention strategies. Results: Cs-CMVi was most common in D-/R+ unrelated donor transplants (URD). Spontaneous CMV clearance occurred in 26% of patients who reached a viral load of 56-137 IU/mL, 6% at 138-250 IU/mL and in one patient >250 IU/mL. Median time between the first CMV reactivation (>56 IU/mL) and a viral load >250 IU/mL was 13 days, whereas the time from the first viral load >250 IU/mL to reach a vial load >1000 IU/mL was 4 days. Cs-CMVi was associated with a significant increase in non-relapse mortality (NRM) on multivariate analysis. Conclusions: Overall, this study indicates that D-/R+ URD recipients are at high-risk for cs-CMVi- and CMV-related mortality, and are potential candidates for targeted CMV prophylaxis. Spontaneous clearance of CMV beyond a viral load of 250 IU/mL is uncommon, suggesting that this could be used as an appropriate threshold to initiate pre-emptive therapy. |
URI: | http://hdl.handle.net/11054/1766 |
DOI: | https://doi.org/10.1111/tid.13548 |
Internal ID Number: | 01720 |
Health Subject: | CYTOMEGALOVIRUS HEMATOPOIETIC CELL TRANSPLANTATION PRE-EMPTIVE THERAPY VIREMIA |
Type: | Journal Article Article |
Appears in Collections: | Research Output |
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