The prognostic impact of the cytomegalovirus serostatus in patients with chronic hematological malignancies after allogeneic hematopoietic stem cell transplantation: a report from the Infectious Diseases Working Party of EBMT.

Abstract

It has been shown recently that donor and/or recipient cytomegalovirus (CMV) seropositivity is associated with a significant overall survival (OS) decline in acute leukemia patients who underwent allogeneic hematopoietic stem cell transplantation (allo-HSCT). We now analyzed the prognostic impact of the donor/recipient CMV serostatus in 6968 patients with chronic hematological malignancies who underwent allo-HSCT. Donor and/or recipient CMV seropositivity was associated with a significantly reduced 2-year progression-free survival (PFS, 50% vs. 52%, p = 0.03) and OS (62% vs. 65%, p = 0.01). Multivariate Cox regression analyses showed an independent negative prognostic impact of donor and/or recipient CMV seropositivity on PFS (HR, 1.1; 95% CI, 1.0-1.2; p = 0.03), OS (HR, 1.1; 95% CI, 1.0-1.2; p = 0.003), and non-relapse mortality (HR, 1.2; 95% CI, 1.0-1.3; p = 0.02). OS decline was strongest for CMV-seropositive recipients with a CMV-seronegative donor (HR, 1.2; 95% CI, 1.1-1.3), followed by CMV-seropositive patients with a CMV-seropositive donor (HR, 1.1; 95% CI, 1.0-1.2). Conversely, OS did not differ significantly between CMV-seronegative recipients allografted from a CMV-seropositive donor (HR, 1.0; 95% CI, 0.9-1.2) and patients with donor/recipient CMV seronegativity (p = 0.001 for the four groups together). Non-relapse mortality was also significantly (p = 0.01) higher for CMV-seropositive patients with a CMV-seronegative graft (HR, 1.2; 95% CI, 1.1-1.4) than for CMV-seropositive patients with a CMV-seropositive graft (HR, 1.1; 95% CI, 0.9-1.2) or CMV-seronegative recipients with a CMV-seropositive graft (HR, 1.0; 95% CI, 0.8-1.2). Donor and/or recipient CMV seropositivity still results in an OS decline in patients with chronic hematological malignancies who have undergone allo-HSCT. However, this OS decline seems to be lower than that described for acute leukemia patients previously.

• Authors: Martin Schmidt-Hieber, Gloria Tridello, Per Ljungman, Malgorzata Mikulska, Nina Knelange, Didier Blaise, Gerard Socié, Liisa Volin, Nicole Blijlevens, Nathalie Fegueux, Ibrahim Yakoub-Agha, Edouard Forcade, Johan Maertens, Patrice Chevallier, Jakob Passweg, Jan Cornelissen, Nigel Russell, Charles Craddock, Jean Henri Bourhis, Tony Marchand, Péter Reményi, Jean Yves Cahn, Mauricette Michallet, Silvia Montoto, Nicolaus Kröger, Bertram Glaß, Jan Styczynski
• Journal: Annals of hematology (Ann Hematol) Vol. 98 Issue 7 Pg. 1755-1763 (Jul 2019) ISSN: 1432-0584 [Electronic] Germany
• PMID: 30993417 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Topics

• Adult
• Aged
• Allografts
• Child
• Child, Preschool
• Chronic Disease
• Cytomegalovirus
• Cytomegalovirus Infections (blood, mortality, therapy)
• Disease-Free Survival
• Donor Selection
• Female
• Hematologic Neoplasms (blood, mortality, therapy)
• Hematopoietic Stem Cell Transplantation
• Humans
• Infant
• Male
• Middle Aged
• Survival Rate
• Tissue Donors