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Cytomegalovirus DNAemia and risk of mortality in allogeneic hematopoietic stem cell transplantation: Analysis from the Spanish Hematopoietic Transplantation and Cell Therapy Group |
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| Authors: | Carlos Solano Lourdes Vázquez Estela Giménez Rafael de la Cámara Eliseo Albert Montserrat Rovira Ildefonso Espigado Carmen M. Calvo Javier López-Jiménez María Suárez-Lledó Anabella Chinea Albert Esquirol Ariadna Pérez Aránzazu Bermúdez Raquel Saldaña Inmaculada Heras Ana J. González-Huerta Tamara Torrado Guiomar Bautista Montserrat Batlle Santiago Jiménez Carlos Vallejo Pere Barba María Á. Cuesta José L. Piñana David Navarro |
| Affiliation: | 1. Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain;2. Hematology Department, Complejo Asistencial Universitario de Salamanca-IBSAL, Salamanca, Spain;3. Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain;4. Hematology Department, Hospital de la Princesa, Madrid, Spain;5. Hematology Department, Hospital Clinic Institute of Hematology & Oncology, Barcelona, Spain;6. Hematology Department, Hospital Virgen del Rocío, Sevilla, Spain;7. Hematology Department, Hospital Universitario Reina Sofía, Córdoba, Spain;8. Hematology Department, Hospital Ramón y Cajal, Madrid, Spain;9. Hematology Department, Hospital Sant Creu i Sant Pau, Barcelona, Spain;10. Hematology Department, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain;11. Department of Hematology, Hospital Marques de Valdecilla, Santander, Spain;12. Hematology Department, Hospital Universitario de Jerez, Jerez de la Frontera, Cádiz, Spain;13. Hematology Department, Hospital Universitario Morales Meseguer y Centro Regional de Hemodonación, IMIB, Universidad de Murcia, Murcia, Spain;14. Hematology-Stem cell Transplantation Unit, Hospital Universitario Central de Asturias, Oviedo IISPA. IUOPA, Oviedo, Spain;15. Hematology Department, Complejo Hospitalario Universitario, Vigo, Spain;16. Hematology Department, Hospital Universitario Puerta de Hierro, Madrid, Spain;17. Hematology Department, Hospital Germans Trias i Pujol, Barcelona, Spain;18. Hematology Department, Hospital Universitario Doctor Negrín de Gran Canaria, Las Palmas, Spain;19. Hematology Department Hospital Universitario Donostia-Aránzazu, San Sebastián, Spain;20. Hematology Department Hospital, Universitario Vall de Hebrón, Barcelona, Spain;21. Hematology Department, Hospital Regional Universitario, Málaga, Spain;22. Hematology Department, Hospital Universitari i Politècnic La Fe, Valencia, Spain CIBERONC, Instituto Carlos III, Madrid, Spain |
| Abstract: | The net impact of cytomegalovirus (CMV) DNAemia on overall mortality (OM) and nonrelapse mortality (NRM) following allogeneic hematopoietic stem cell transplantation (allo-HSCT) remains a matter of debate. This was a retrospective, multicenter, noninterventional study finally including 749 patients. CMV DNA monitoring was conducted by real-time polymerase chain reaction (PCR) assays. Clinical outcomes of interest were OM and NRM through day 365 after allo-HSCT. The cumulative incidence of CMV DNAemia in this cohort was 52.6%. A total of 306 out of 382 patients with CMV DNAemia received preemptive antiviral therapy (PET). PET use for CMV DNAemia, but not the occurrence of CMV DNAemia, taken as a qualitative variable, was associated with increased OM and NRM in univariate but not in adjusted models. A subcohort analysis including patients monitored by the COBAS Ampliprep/COBAS Taqman CMV Test showed that OM and NRM were comparable in patients in whom either low or high plasma CMV DNA threshold (<500 vs ≥500 IU/mL) was used for PET initiation. In conclusion, CMV DNAemia was not associated with increased OM and NRM in allo-HSCT recipients. The potential impact of PET use on mortality was not proven but merits further research. |
| Keywords: | bone marrow/hematopoietic stem cell transplantation clinical research/practice complication: infectious infection and infectious agents – viral: Cytomegalovirus (CMV) |