| Autor: |
Nancy A. Kernan, Jaap-Jan Boelens, Audrey Mauguen, Susan E. Prockop, Irene Rodriguez-Sanchez, Maria Cancio, Genovefa A. Papanicolaou, Christine Camacho-Bydume, Elizabeth Klein |
| Rok vydání: |
2020 |
| Předmět: |
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| Zdroj: |
Biology of Blood and Marrow Transplantation. 26:S347 |
| ISSN: |
1083-8791 |
| DOI: |
10.1016/j.bbmt.2019.12.382 |
| Popis: |
Background Despite significant advances in viral detection and treatment, reactivation of cytomegalovirus (CMV) remains a major complication following allogeneic hematopoietic cell transplant (allo-HCT). Methods to decrease the risk of CMV reactivation and long-term sequelae of CMV disease include controlling for known risk factors and administering appropriate antiviral treatments. Although they are shown to be effective, these treatments carry considerable adverse effects that may limit their use. The optimal timing to initiate induction treatment remains unclear, especially in the pediatric population. Design We performed a retrospective analysis of patients who received initial conventional or ex-vivo T-cell depleted (TCD) allo-HCT on the pediatric service from January 2010 – June 2018 at Memorial Sloan Kettering Cancer Center. CMV reactivation was defined as ≥ 1 CMV PCR >500 in whole blood or >137 in plasma within 180 days post-transplant. Induction treatment was typically initiated for CMV PCR ≥ 1000 in whole blood, ≥ 300 in plasma, or rising viremia from baseline. Hospital databases and medical records were utilized to identify patients and collect clinical data. Time-dependent Cox models and multi-state models to account for competing risks were used. This study was approved by Institutional Review Board. Results Our study consisted of 227 patients (54 days - 27 years old) who underwent allo-HCT for malignant (N=143) and non-malignant (N=84) diseases. TCD represented 76% of all allografts. CMV donor (D) and recipient (R) serostatus were: D+/R+ N=90, D+/R- N=29, D-/R+ N=38, D-/R- N=70. Cumulative incidence of CMV reactivation was 24.8% and 15 patients (27%) developed CMV disease. Median time to CMV reactivation was 24 days (IQR 14-33). Of the 56 patients who reactivated, 41 (73%) patients received induction treatment. The median time from CMV reactivation to induction treatment was 6 days (IQR 1-15). D+/R+ serostatus was a predictor for CMV reactivation when compared to D-/R+ (HR=2.1, [95% CI 1.1 - 4, P Conclusions A short interval between CMV reactivation and initiation of induction treatment was significantly associated with improved OS in TCD HCT. Earlier treatment did not translate into improved outcomes, which may be confounded by high-risk patients receiving induction therapies earlier. Further evaluation into CMV prophylaxis and prompt initiation of induction treatment on additional CMV outcomes will help optimize treatment options and improve clinical outcomes. |
| Databáze: |
OpenAIRE |
| Externí odkaz: |
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