CLINIC RISK FACTORS OF REFRACTORY CMV REACTIVATION FOLLOWING ALLOGENEIC AHSCT: A SINGLE-CENTER STUDY IN CHINA
(Abstract release date: 05/19/16)
EHA Library. Qiu H. 06/09/16; 132717; E1168
Prof. Dr. Huiying Qiu
Contributions
Contributions
Abstract
Abstract: E1168
Type: Eposter Presentation
Background
Cytomegalovirus (CMV) reactivation remains the main cause of viral complications after allogeneic hematopoietic stem cell transplantation (aHSCT). Especially, CMV with gene mutations against antiviral drugs could lead to high mortality rate.
Aims
The purpose of this study is to explore the risk factors and outcome for CMV reactivation and CMV refractory to antiviral chemotherapy after aHSCT.
Methods
CMV reactivation occurred in 282 of 685 (41.2%) patients treated with myeloablative conditioning regimen. Among the patients with CMV reactivation, 84 of 282 (29.8%) cases developed refractory CMV reactivation (RCR), and 37 of 282 (13.1%) cases progressed into CMV diseases.
Results
Patients with RCR have a higher cumulative incidence of CMV diseases (26.2% versus 7.6%, P<0.001). Seventy nine of 84 cases (94.0%) developed RCR before 100 days after aHSCT (5 cases with PP65 detection only). The copy number of CMV-DNA more than doubled compared to its initial baseline in 42 of 74 (56.8%) cases after 2 weeks of antiviral therapy, whereas 32 cases did not have a double increase above baseline. CMV disease developed in 15 of 42 (35.7%) and 3 of 32 (9.4%) (P=0.011) cases in these two groups. The copy number of CMV-DNA increased at least 5 times above baseline in 24 of 74 (32.4%) patients, and among these 24 patients, 8 of 24 (33.3%) cases developed CMV disease. Among patients who do not have a 5-fold increase of CMV-DNA copy number, 10 of 50 (20.0%) patients developed CMV disease (P=0.232). Both univariate and multivariate analysis demonstrated that the risk of CMV reactivation and RCR increased in patients from HLA-haploidentical donor and matched unrelated donor, or without using peripheral blood (PB) as stem cell source. The multivariate analysis revealed that patients who developed acute graft-versus-host disease (aGVHD) ≥ grade 2 have increased risk of developing CMV reactivation, whereas RCR occurred more frequently in those with total body irradiation-containing regimens and a high dosage methylprednisolone (MP) for aGVHD treatment. The prevalence of RCR is three and six times higher in patients who received MP 1-2mg/kg daily(P=0.024) and ≥2mg/kg daily(P=0.001), with an odds ratio (OR) of 2.74 and 6.03 respectively.
Conclusion
High dosage corticosteroids treatment is associated with incidence of RCR during the early phase after aHSCT.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, CMV
Type: Eposter Presentation
Background
Cytomegalovirus (CMV) reactivation remains the main cause of viral complications after allogeneic hematopoietic stem cell transplantation (aHSCT). Especially, CMV with gene mutations against antiviral drugs could lead to high mortality rate.
Aims
The purpose of this study is to explore the risk factors and outcome for CMV reactivation and CMV refractory to antiviral chemotherapy after aHSCT.
Methods
CMV reactivation occurred in 282 of 685 (41.2%) patients treated with myeloablative conditioning regimen. Among the patients with CMV reactivation, 84 of 282 (29.8%) cases developed refractory CMV reactivation (RCR), and 37 of 282 (13.1%) cases progressed into CMV diseases.
Results
Patients with RCR have a higher cumulative incidence of CMV diseases (26.2% versus 7.6%, P<0.001). Seventy nine of 84 cases (94.0%) developed RCR before 100 days after aHSCT (5 cases with PP65 detection only). The copy number of CMV-DNA more than doubled compared to its initial baseline in 42 of 74 (56.8%) cases after 2 weeks of antiviral therapy, whereas 32 cases did not have a double increase above baseline. CMV disease developed in 15 of 42 (35.7%) and 3 of 32 (9.4%) (P=0.011) cases in these two groups. The copy number of CMV-DNA increased at least 5 times above baseline in 24 of 74 (32.4%) patients, and among these 24 patients, 8 of 24 (33.3%) cases developed CMV disease. Among patients who do not have a 5-fold increase of CMV-DNA copy number, 10 of 50 (20.0%) patients developed CMV disease (P=0.232). Both univariate and multivariate analysis demonstrated that the risk of CMV reactivation and RCR increased in patients from HLA-haploidentical donor and matched unrelated donor, or without using peripheral blood (PB) as stem cell source. The multivariate analysis revealed that patients who developed acute graft-versus-host disease (aGVHD) ≥ grade 2 have increased risk of developing CMV reactivation, whereas RCR occurred more frequently in those with total body irradiation-containing regimens and a high dosage methylprednisolone (MP) for aGVHD treatment. The prevalence of RCR is three and six times higher in patients who received MP 1-2mg/kg daily(P=0.024) and ≥2mg/kg daily(P=0.001), with an odds ratio (OR) of 2.74 and 6.03 respectively.
Conclusion
High dosage corticosteroids treatment is associated with incidence of RCR during the early phase after aHSCT.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, CMV
Abstract: E1168
Type: Eposter Presentation
Background
Cytomegalovirus (CMV) reactivation remains the main cause of viral complications after allogeneic hematopoietic stem cell transplantation (aHSCT). Especially, CMV with gene mutations against antiviral drugs could lead to high mortality rate.
Aims
The purpose of this study is to explore the risk factors and outcome for CMV reactivation and CMV refractory to antiviral chemotherapy after aHSCT.
Methods
CMV reactivation occurred in 282 of 685 (41.2%) patients treated with myeloablative conditioning regimen. Among the patients with CMV reactivation, 84 of 282 (29.8%) cases developed refractory CMV reactivation (RCR), and 37 of 282 (13.1%) cases progressed into CMV diseases.
Results
Patients with RCR have a higher cumulative incidence of CMV diseases (26.2% versus 7.6%, P<0.001). Seventy nine of 84 cases (94.0%) developed RCR before 100 days after aHSCT (5 cases with PP65 detection only). The copy number of CMV-DNA more than doubled compared to its initial baseline in 42 of 74 (56.8%) cases after 2 weeks of antiviral therapy, whereas 32 cases did not have a double increase above baseline. CMV disease developed in 15 of 42 (35.7%) and 3 of 32 (9.4%) (P=0.011) cases in these two groups. The copy number of CMV-DNA increased at least 5 times above baseline in 24 of 74 (32.4%) patients, and among these 24 patients, 8 of 24 (33.3%) cases developed CMV disease. Among patients who do not have a 5-fold increase of CMV-DNA copy number, 10 of 50 (20.0%) patients developed CMV disease (P=0.232). Both univariate and multivariate analysis demonstrated that the risk of CMV reactivation and RCR increased in patients from HLA-haploidentical donor and matched unrelated donor, or without using peripheral blood (PB) as stem cell source. The multivariate analysis revealed that patients who developed acute graft-versus-host disease (aGVHD) ≥ grade 2 have increased risk of developing CMV reactivation, whereas RCR occurred more frequently in those with total body irradiation-containing regimens and a high dosage methylprednisolone (MP) for aGVHD treatment. The prevalence of RCR is three and six times higher in patients who received MP 1-2mg/kg daily(P=0.024) and ≥2mg/kg daily(P=0.001), with an odds ratio (OR) of 2.74 and 6.03 respectively.
Conclusion
High dosage corticosteroids treatment is associated with incidence of RCR during the early phase after aHSCT.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, CMV
Type: Eposter Presentation
Background
Cytomegalovirus (CMV) reactivation remains the main cause of viral complications after allogeneic hematopoietic stem cell transplantation (aHSCT). Especially, CMV with gene mutations against antiviral drugs could lead to high mortality rate.
Aims
The purpose of this study is to explore the risk factors and outcome for CMV reactivation and CMV refractory to antiviral chemotherapy after aHSCT.
Methods
CMV reactivation occurred in 282 of 685 (41.2%) patients treated with myeloablative conditioning regimen. Among the patients with CMV reactivation, 84 of 282 (29.8%) cases developed refractory CMV reactivation (RCR), and 37 of 282 (13.1%) cases progressed into CMV diseases.
Results
Patients with RCR have a higher cumulative incidence of CMV diseases (26.2% versus 7.6%, P<0.001). Seventy nine of 84 cases (94.0%) developed RCR before 100 days after aHSCT (5 cases with PP65 detection only). The copy number of CMV-DNA more than doubled compared to its initial baseline in 42 of 74 (56.8%) cases after 2 weeks of antiviral therapy, whereas 32 cases did not have a double increase above baseline. CMV disease developed in 15 of 42 (35.7%) and 3 of 32 (9.4%) (P=0.011) cases in these two groups. The copy number of CMV-DNA increased at least 5 times above baseline in 24 of 74 (32.4%) patients, and among these 24 patients, 8 of 24 (33.3%) cases developed CMV disease. Among patients who do not have a 5-fold increase of CMV-DNA copy number, 10 of 50 (20.0%) patients developed CMV disease (P=0.232). Both univariate and multivariate analysis demonstrated that the risk of CMV reactivation and RCR increased in patients from HLA-haploidentical donor and matched unrelated donor, or without using peripheral blood (PB) as stem cell source. The multivariate analysis revealed that patients who developed acute graft-versus-host disease (aGVHD) ≥ grade 2 have increased risk of developing CMV reactivation, whereas RCR occurred more frequently in those with total body irradiation-containing regimens and a high dosage methylprednisolone (MP) for aGVHD treatment. The prevalence of RCR is three and six times higher in patients who received MP 1-2mg/kg daily(P=0.024) and ≥2mg/kg daily(P=0.001), with an odds ratio (OR) of 2.74 and 6.03 respectively.
Conclusion
High dosage corticosteroids treatment is associated with incidence of RCR during the early phase after aHSCT.
Session topic: E-poster
Keyword(s): Allogeneic hematopoietic stem cell transplant, CMV
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