Impact of cytomegalovirus reactivation on relapse and survival in patients with acute leukemia who received allogeneic hematopoietic stem cell transplantation in first remission

Oncotarget
Jae-Ho YoonJong Wook Lee

Abstract

Cytomegalovirus (CMV)-reactivation is associated with graft-vs-leukemia (GVL) effect by stimulating natural-killer or T-cells, which showed leukemia relapse prevention after hematopoietic stem cell transplantation (HSCT). We enrolled patients with acute myeloid leukemia (n = 197) and acute lymphoid leukemia (n = 192) who underwent allogeneic-HSCT in first remission. We measured RQ-PCR weekly to detect CMV-reactivation and preemptively used ganciclovir (GCV) when the titer increased twice consecutively, but GCV was sometimes delayed in patients without significant graft-vs-host disease (GVHD) by reducing immunosuppressive agents. In the entire group, CMV-reactivation showed poor overall survival (OS). To evaluate subsequent effects of CMV-reactivation, we excluded early relapse and deaths within 100 days, during which most of the CMV-reactivation occurred. Untreated CMV-reactivated group (n = 173) showed superior OS (83.8% vs. 61.7% vs. 74.0%, p < 0.001) with lower relapse rate (10.1% vs 22.1% vs. 25.5%, p = 0.004) compared to GCV-treated CMV-reactivated group (n = 122) and CMV-undetected group (n = 42). After excluding chronic GVHD, untreated CMV-reactivated group still showed lower relapse rate (9.4% vs. 24.1% vs. 30.2%, p = 0...Continue Reading

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Citations

Jul 6, 2018·Transplant Infectious Disease : an Official Journal of the Transplantation Society·Brandon J WebbDaanish Hoda
Jun 4, 2019·International Journal of Molecular Sciences·Sung-Yeon ChoHee-Je Kim
Jun 28, 2019·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Estela GiménezDavid Navarro
Jun 9, 2020·HLA : Immune Response Genetics·Gi-June MinJong Wook Lee
Jan 25, 2017·Journal of Immunology Research·Baixin YeXiaoxing Xiong
Aug 20, 2020·American Journal of Transplantation : Official Journal of the American Society of Transplantation and the American Society of Transplant Surgeons·Carlos SolanoDavid Navarro
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Apr 21, 2020·Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation·Hisayuki YokoyamaUNKNOWN Japan Society for Hematopoietic Cell Transplantation Transplantation-Related Complication Working Group

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