Cytomegalovirus DNAemia and risk of mortality in allogeneic hematopoietic stem cell transplantation: Analysis from the Spanish Hematopoietic Transplantation and Cell Therapy Group

• Published in: American journal of transplantation Vol. 21; no. 1; pp. 258 - 271
• Main Authors: Solano, Carlos, Vázquez, Lourdes, Giménez, Estela, Cámara, Rafael, Albert, Eliseo, Rovira, Montserrat, Espigado, Ildefonso, Calvo, Carmen M., López‐Jiménez, Javier, Suárez‐Lledó, María, Chinea, Anabella, Esquirol, Albert, Pérez, Ariadna, Bermúdez, Aránzazu, Saldaña, Raquel, Heras, Inmaculada, González‐Huerta, Ana J., Torrado, Tamara, Bautista, Guiomar, Batlle, Montserrat, Jiménez, Santiago, Vallejo, Carlos, Barba, Pere, Cuesta, María Á., Piñana, José L., Navarro, David
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.01.2021
• Subjects: Antiviral agents; Antiviral drugs; Bone marrow; bone marrow/hematopoietic stem cell transplantation; Cell therapy; clinical research/practice; complication: infectious; Cytomegalovirus; Cytomegalovirus - genetics; Cytomegalovirus Infections; Deoxyribonucleic acid; DNA; DNA, Viral - genetics; Hematopoietic Stem Cell Transplantation - adverse effects; Hematopoietic stem cells; Humans; infection and infectious agents – viral: Cytomegalovirus (CMV); Mortality; Polymerase chain reaction; Retrospective Studies; Stem cell transplantation; Stem cells; Transplantation, Homologous - adverse effects; bone marrow/hematopoietic stem cell transplantation; infection and infectious agents - viral: Cytomegalovirus (CMV); clinical research/practice; complication: infectious
• ISSN: 1600-6135; 1600-6143; 1600-6143
• DOI: 10.1111/ajt.16147

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. Among allogeneic hematopoietic stem cell transplant recipients, cytomegalovirus DNAemia, considered as a qualitative variable, is not associated with increased all‐cause or nonrelapse mortality, irrespective of the threshold of CMV DNA used to trigger preemptive antiviral therapy.