Contributions
Abstract: PB2420
Type: Publication Only
Background
Anti thymocyte globulin (polyclonal anti T cell antibody preparation) is used in pre transplant conditioning regimen to reduce the risk of GvHD and graft rejection emanating from allo-reactivity of donor and recipient, which is reduced by CD34+ lymphocyte depletion. ATG has improved overall survival due to better GvHD prophylaxis. On the other hand, T-cell depletion regimen (ATG) increases the risk of opportunistic infections and hence increase transplant related mortality. Cytomegalovirus (CMV) infection or antigenemia is a significant risk factor in transplant related morbidity and mortality.
Aims
To determine if GvHD prophylaxis with r-ATG increased CMV reactivation 100 days post-transplant in allogeneic stem cell transplant recipients. The primary outcome will be the incidence of CMV at 100 days
Methods
This retrospective study evaluated patients who received an allogeneic stem cell transplant for malignant and non malignant hematological disorders from June 2015 to 2017, at National Institute of Blood Disease and Bone Marrow Transplantation. Pre Transplant CMV serology was performed in all donors and recipients. All recipients received leucodepleted blood products and oral Acyclovir for CMV prophylaxis. CMV antigen by PCR was routinely done twice weekly in all patients. For preemptive treatment of CMV ganciclovir was offered to all patients with >100copies/ml.
Results
100 patients with hematological disorders included: Thalasemia major (n=44), Aplastic anemia (n=30), Fanconi Anemia (n=8), Acute myeloid leukemia (n= 7), Chronic myelogenous leukemia (n=2), Paroxysmal nocturnal hemoglobinuria (n=2),acute lymphoblastic leukemia (n=1), Gaucher’s Disease (n=1) and Myelodysplastic syndrome (n=1), PRCA (n=1), Sideroblastic Anemia(n=1), severe combined immunodeficiency (n=1), Hemophagocytic lymphohistiocytosis (n=1)
Mean age of patient at time of transplantation was 10.45±9.2years, 9 patients underwent haplo-identical and 91 were full matched allergenic bone marrow transplantation. Neutrophil and platelet engraftments were achieved in median days of 13(10-29) and 16(10-42) respectively.
CMV reactivation was observed in 38/64(59%) patients who received ATG based conditioning regimen versus 14/36(39%) patients who did not receive ATG which was clinically and statistically significant.
Median duration of CMV reactivation was 13(range=1-42) days post transplant. Treatment related neutropenia (grade II-III) was observed in 7 patients after ganciclovir therapy.CMV infection (Pneumonitis) was documented in 1 patient. Acute GvHD of gut and skin was observed in 7 and 1 patient respectively. Secondary graft failure was observed in 3/52(5.7%) CMV positive and 2/48 (4.2%) in patients with negative CMV.
Conclusion
CMV reactivation is increased when r-ATG is used as part of the conditioning regimen for GvHD prophylaxis. Large number of patients and follow-up over longer period of time data is still needed to establish CMV as a risk factor for secondary graft failure in allogeneic transplant recipients.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): ATG, Conditioning, Cytomegalovirus, Transplant
Abstract: PB2420
Type: Publication Only
Background
Anti thymocyte globulin (polyclonal anti T cell antibody preparation) is used in pre transplant conditioning regimen to reduce the risk of GvHD and graft rejection emanating from allo-reactivity of donor and recipient, which is reduced by CD34+ lymphocyte depletion. ATG has improved overall survival due to better GvHD prophylaxis. On the other hand, T-cell depletion regimen (ATG) increases the risk of opportunistic infections and hence increase transplant related mortality. Cytomegalovirus (CMV) infection or antigenemia is a significant risk factor in transplant related morbidity and mortality.
Aims
To determine if GvHD prophylaxis with r-ATG increased CMV reactivation 100 days post-transplant in allogeneic stem cell transplant recipients. The primary outcome will be the incidence of CMV at 100 days
Methods
This retrospective study evaluated patients who received an allogeneic stem cell transplant for malignant and non malignant hematological disorders from June 2015 to 2017, at National Institute of Blood Disease and Bone Marrow Transplantation. Pre Transplant CMV serology was performed in all donors and recipients. All recipients received leucodepleted blood products and oral Acyclovir for CMV prophylaxis. CMV antigen by PCR was routinely done twice weekly in all patients. For preemptive treatment of CMV ganciclovir was offered to all patients with >100copies/ml.
Results
100 patients with hematological disorders included: Thalasemia major (n=44), Aplastic anemia (n=30), Fanconi Anemia (n=8), Acute myeloid leukemia (n= 7), Chronic myelogenous leukemia (n=2), Paroxysmal nocturnal hemoglobinuria (n=2),acute lymphoblastic leukemia (n=1), Gaucher’s Disease (n=1) and Myelodysplastic syndrome (n=1), PRCA (n=1), Sideroblastic Anemia(n=1), severe combined immunodeficiency (n=1), Hemophagocytic lymphohistiocytosis (n=1)
Mean age of patient at time of transplantation was 10.45±9.2years, 9 patients underwent haplo-identical and 91 were full matched allergenic bone marrow transplantation. Neutrophil and platelet engraftments were achieved in median days of 13(10-29) and 16(10-42) respectively.
CMV reactivation was observed in 38/64(59%) patients who received ATG based conditioning regimen versus 14/36(39%) patients who did not receive ATG which was clinically and statistically significant.
Median duration of CMV reactivation was 13(range=1-42) days post transplant. Treatment related neutropenia (grade II-III) was observed in 7 patients after ganciclovir therapy.CMV infection (Pneumonitis) was documented in 1 patient. Acute GvHD of gut and skin was observed in 7 and 1 patient respectively. Secondary graft failure was observed in 3/52(5.7%) CMV positive and 2/48 (4.2%) in patients with negative CMV.
Conclusion
CMV reactivation is increased when r-ATG is used as part of the conditioning regimen for GvHD prophylaxis. Large number of patients and follow-up over longer period of time data is still needed to establish CMV as a risk factor for secondary graft failure in allogeneic transplant recipients.
Session topic: 23. Stem cell transplantation - Clinical
Keyword(s): ATG, Conditioning, Cytomegalovirus, Transplant