Contributions
Abstract: EP1281
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Cytomegalovirus (CMV) infection is one of the major cause of morbidity and non-relapse mortality in allogeneic hematopoietic stem cell transplantation (aHSCT). There are many recognized risk factors for CMV infection or reactivation after aHSCT, being the most important CMV donor/recipient (D/R) serostatus and ocurrence of acute graft versus host disease (aGvHD). CMV infection can affect almost any organ, however, the most important clinical entities are pneumonia, gastroenteritis and retinitis.
Although some studies have shown that novel antiviral drugs should have a role in a prophylactic strategy, our current strategy is yet preemptive, based on regular pp65 antigenemia assays or qPCR.
Aims
The primary objective was to recognize and characterize prognostic factors related to CMV infection in post-transplant recipients. Moreover, we analyzed the impact of CMV infection in HSCT outcomes, respecting overall survival and non-relapse mortality.
Methods
A retrospective unicenter study was conducted in a cohort of 326 patients with hematological disease who underwent allogeneic stem cell transplant between January 2014 and December 2018. Analysis of survival and statistical comparison was made using the SPSS26® platform
Results
The median follow up time of our study was 26 months. Our cohort showed a male predominance (55% n=178) and a median age of 43 years, with 51 pediatric patients. The primary diseases were hematological malignancies in 89,6% (n=293) . There was an almost even distribution of donor type (related 50% n=163, unrelated (MUD) 50% N=163) and conditioning regimen (mieloablative 47% n= 154 and reduced-intensity 53% N=172). Matched HLA donors constituted 73% (n=238) and mismatched donors were 27% (n=83) (26% HLA 9/10 or 8/10 and 1% haploidentical). Recipients were mostly seropositive for CMV infection (87% n=284) as well as donors (66% n=217). In respect to D/R serostatus the most frequent was D+/R+ (60,7%) followed by D-/R+ (26.4%), D+/R- (8.9%) and D-/R- (4%).
The incidence of aGvHD and chronic GvHD in this study was 51% (n=167) (91% with grade ≥ 2) and 32.5% (n=106), respectively.
CMV infection occurred in 46% of our cohort, with a median time to infection of 36 days (3-391d) and a median first infection time of 19 days (3-129d). Prognostic factors that impact the risk of infection were donor type (MUD – odds ratio (OR) 1.3 p=0.014), donor (IgG- OR 1.58 p=0.006) and recipient CMV seropositivity (IgG+ 1.18 p=0.000), D/R status (D-/R+ OR 2.09 p=0.000) and development of aGvHD (OR 1.9 p=0.000).
In our study, relapse was observed in 16% (n=51) of the cohort and 5% (n=17) of the sample died without evaluation of primary disease status. CMV infection has an impact on overall survival (2yOS 46.2% with infection vs 66.1% without, (with infection OR 1.51, p=0.001) and non-relapse mortality (2yOS 56% with infection vs 81.5% without infection (with infection OR 1.82, p=0.000).
Conclusion
CMV is still a major cause of morbidity and mortality in patients post allogeneic transplant and is of greater importance to recognize prognostic factors that increase the risk of reactivation. Our study confirms the role of classical risk factors in CMV infection. Despite the expected impact of prophylactic therapy in the incidence of CMV infection is still important to search for the best donor available regarding a multiplicity of factors as well CMV D/R status.
Keyword(s): Cytomegalovirus, Infection, Stem cell transplant
Abstract: EP1281
Type: E-Poster Presentation
Session title: Stem cell transplantation - Clinical
Background
Cytomegalovirus (CMV) infection is one of the major cause of morbidity and non-relapse mortality in allogeneic hematopoietic stem cell transplantation (aHSCT). There are many recognized risk factors for CMV infection or reactivation after aHSCT, being the most important CMV donor/recipient (D/R) serostatus and ocurrence of acute graft versus host disease (aGvHD). CMV infection can affect almost any organ, however, the most important clinical entities are pneumonia, gastroenteritis and retinitis.
Although some studies have shown that novel antiviral drugs should have a role in a prophylactic strategy, our current strategy is yet preemptive, based on regular pp65 antigenemia assays or qPCR.
Aims
The primary objective was to recognize and characterize prognostic factors related to CMV infection in post-transplant recipients. Moreover, we analyzed the impact of CMV infection in HSCT outcomes, respecting overall survival and non-relapse mortality.
Methods
A retrospective unicenter study was conducted in a cohort of 326 patients with hematological disease who underwent allogeneic stem cell transplant between January 2014 and December 2018. Analysis of survival and statistical comparison was made using the SPSS26® platform
Results
The median follow up time of our study was 26 months. Our cohort showed a male predominance (55% n=178) and a median age of 43 years, with 51 pediatric patients. The primary diseases were hematological malignancies in 89,6% (n=293) . There was an almost even distribution of donor type (related 50% n=163, unrelated (MUD) 50% N=163) and conditioning regimen (mieloablative 47% n= 154 and reduced-intensity 53% N=172). Matched HLA donors constituted 73% (n=238) and mismatched donors were 27% (n=83) (26% HLA 9/10 or 8/10 and 1% haploidentical). Recipients were mostly seropositive for CMV infection (87% n=284) as well as donors (66% n=217). In respect to D/R serostatus the most frequent was D+/R+ (60,7%) followed by D-/R+ (26.4%), D+/R- (8.9%) and D-/R- (4%).
The incidence of aGvHD and chronic GvHD in this study was 51% (n=167) (91% with grade ≥ 2) and 32.5% (n=106), respectively.
CMV infection occurred in 46% of our cohort, with a median time to infection of 36 days (3-391d) and a median first infection time of 19 days (3-129d). Prognostic factors that impact the risk of infection were donor type (MUD – odds ratio (OR) 1.3 p=0.014), donor (IgG- OR 1.58 p=0.006) and recipient CMV seropositivity (IgG+ 1.18 p=0.000), D/R status (D-/R+ OR 2.09 p=0.000) and development of aGvHD (OR 1.9 p=0.000).
In our study, relapse was observed in 16% (n=51) of the cohort and 5% (n=17) of the sample died without evaluation of primary disease status. CMV infection has an impact on overall survival (2yOS 46.2% with infection vs 66.1% without, (with infection OR 1.51, p=0.001) and non-relapse mortality (2yOS 56% with infection vs 81.5% without infection (with infection OR 1.82, p=0.000).
Conclusion
CMV is still a major cause of morbidity and mortality in patients post allogeneic transplant and is of greater importance to recognize prognostic factors that increase the risk of reactivation. Our study confirms the role of classical risk factors in CMV infection. Despite the expected impact of prophylactic therapy in the incidence of CMV infection is still important to search for the best donor available regarding a multiplicity of factors as well CMV D/R status.
Keyword(s): Cytomegalovirus, Infection, Stem cell transplant