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Posttransplant cyclophosphamide is associated with increased cytomegalovirus infection: a CIBMTR analysis
Resource type
Journal Article
Authors/contributors
- Goldsmith, Scott R. (Author)
- Abid, Muhammad Bilal (Author)
- Auletta, Jeffery J. (Author)
- Bashey, Asad (Author)
- Beitinjaneh, Amer (Author)
- Castillo, Paul (Author)
- Chemaly, Roy F. (Author)
- Chen, Min (Author)
- Ciurea, Stefan (Author)
- Dandoy, Christopher E. (Author)
- Díaz, Miguel Ángel (Author)
- Fuchs, Ephraim (Author)
- Ganguly, Siddhartha (Author)
- Kanakry, Christopher G. (Author)
- Kanakry, Jennifer A. (Author)
- Kim, Soyoung (Author)
- Komanduri, Krishna V. (Author)
- Krem, Maxwell M. (Author)
- Lazarus, Hillard M. (Author)
- Liu, Hongtao (Author)
- Ljungman, Per (Author)
- Masiarz, Richard (Author)
- Mulroney, Carolyn (Author)
- Nathan, Sunita (Author)
- Nishihori, Taiga (Author)
- Page, Kristin M. (Author)
- Perales, Miguel-Angel (Author)
- Taplitz, Randy (Author)
- Romee, Rizwan (Author)
- Riches, Marcie (Author)
- on behalf of the CIBMTR Infection and Immune Reconstitution Working Committee (Author)
Title
Posttransplant cyclophosphamide is associated with increased cytomegalovirus infection: a CIBMTR analysis
Abstract
Prior studies suggest increased cytomegalovirus (CMV) infection after haploidentical donor transplantation with posttransplant cyclophosphamide (HaploCy). The role of allograft source and posttransplant cyclophosphamide (PTCy) in CMV infection is unclear. We analyzed the effect of graft source and PTCy on incidence of CMV infection, and effects of serostatus and CMV infection on transplant outcomes. We examined patients reported to the Center for International Blood and Marrow Transplantation Research between 2012 and 2017 who had received HaploCy (n = 757), matched related (Sib) with PTCy (SibCy, n = 403), or Sib with calcineurin inhibitor-based prophylaxis (SibCNI, n = 1605). Cumulative incidences of CMV infection by day 180 were 42%, 37%, and 23%, respectively (P < .001). CMV disease was statistically comparable. CMV infection risk was highest for CMV-seropositive recipients (R+), but significantly higher in PTCy recipients regardless of donor (HaploCy [n = 545]: hazard ratio [HR], 50.3; SibCy [n = 279]: HR, 47.7; SibCNI [n = 1065]: HR, 24.4; P < .001). D+/R− patients also had increased risk for CMV infection. Among R+ or those developing CMV infection, HaploCy had worse overall survival and nonrelapse mortality. Relapse was unaffected by CMV infection or serostatus. PTCy was associated with lower chronic graft-versus-host disease (GVHD) overall, but CMV infection in PTCy recipients was associated with higher chronic GVHD (P = .006). PTCy, regardless of donor, is associated with higher incidence of CMV infection, augmenting the risk of seropositivity. Additionally, CMV infection may negate the chronic GVHD protection of PTCy. This study supports aggressive prevention strategies in all receiving PTCy.
Publication
Blood
Date
June 10, 2021
Volume
137
Issue
23
Pages
3291-3305
Journal Abbr
Blood
Accessed
6/19/21, 12:03 PM
ISSN
0006-4971
Short Title
Posttransplant cyclophosphamide is associated with increased cytomegalovirus infection
Library Catalog
Silverchair
Citation
Goldsmith, S. R., Abid, M. B., Auletta, J. J., Bashey, A., Beitinjaneh, A., Castillo, P., Chemaly, R. F., Chen, M., Ciurea, S., Dandoy, C. E., Díaz, M. Á., Fuchs, E., Ganguly, S., Kanakry, C. G., Kanakry, J. A., Kim, S., Komanduri, K. V., Krem, M. M., Lazarus, H. M., … on behalf of the CIBMTR Infection and Immune Reconstitution Working Committee. (2021). Posttransplant cyclophosphamide is associated with increased cytomegalovirus infection: a CIBMTR analysis. Blood, 137(23), 3291–3305. https://doi.org/10.1182/blood.2020009362
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