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Abstract

Background

Cytomegalovirus (CMV) infection is a frequent complication after allogeneic hematopoietic cell transplant (allo-HCT) and may increase the risk of other viral infections through its immunomodulatory effects. Donor CMV serology (seropositive [D+] or seronegative donor [D-]) in CMV-seropositive (R+) or seronegative recipients (R-) may impact outcomes post allo-HCT. We analyzed the significance of donor CMV serostatus in a large cohort of alloHCT recipients.

Methods

This is a single-center, retrospective cohort study of 651 allo-HCT recipients cared for at our institution between March 2016 and December 2018. Data on baseline demographics, transplant characteristics, preventive strategies, CMV infection characteristics, and transplant-related outcomes (development of graft versus host disease (GVHD), all-cause mortality, and non-relapse mortality) were collected. A univariate analysis was performed for outcomes of interest using CMV serostatus D-/R- as a control group.

Results
Out of the 651 allo-HCT recipients, 77 were D-/R-, 43 D+/R-, 290 D+/R+, and 241 D-/R+ (table 1). Most patients underwent HCT for AML (40%), received myeloablative conditioning (51%), and had a matched unrelated donor (MUD) HCT (46%). In 2018, letermovir was used in 27% of the D+/R+, 18% of the D-/R+ allo-HCT recipients (table 1) for a total of 116 (55%) allo-HCT recipients. Compared to the CMV D-/R- group, D+/R+ and D-/R+ groups (table 2) had a greater incidence of clinically signicant CMV infections (CS-CMVi) (3.9% vs. 40% vs. 50.6%; all p< 0.01, respectively), CMV end organ disease (0% vs. 14.8% vs. 19.1%; all p< 0.001, respectively), and refractory/resistant (R/R) CMV infections (0% vs. 5.5% vs. 12.4%; all p< 0.03, respectively) with 48 weeks of allo-HCT. CS-CMVi and R/R CMV was more common in D-/R+ allo-HCT when compared to D+/R+ group (50.6% vs. 40.0%, p< 0.001). D-/R+ allo-HCT had worse non-relapse mortality at day 100 compared to D-/R- (3.9% vs. 10.8%, p=0.07).
Baseline characteristics
Table 1:

Baseline characteristics

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Outcome analysis
Table 2:

Outcome analysis

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Conclusion

Allo-HCT recipients with CMV seronegative donor and recipient had less CMV related complications and a trend towards better survival when compared to D-/R+ allo-HCT. CMV D-/R+ HCT recipients had greater CMV related complications when compared to CMV D+/R+ HCT recipients, possibly due to the protective affect of donor seropositivity.

Disclosures

Terri Lynn Shigle, PharmD, BCOP, Takeda: Advisor/Consultant Gabriella Rondon, MD, Omeros: Advisor/Consultant Elizabeth Shpall, MD, Adaptimmune: Advisor/Consultant|Affimed: License agreement|Axio: Advisor/Consultant|Bayer Helathcare Pharmaceuticals: Honoraria|Fibroblasts and FibrioBiologics: Advisor/Consultant|Navan: Advisor/Consultant|NY Blood Center: Advisor/Consultant|Takeda: License agreement Ella Ariza-Heredia, MD, MERCK: Grant/Research Support Roy F. Chemaly, MD/MPH, Karius: Advisor/Consultant|Karius: Grant/Research Support.

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Author notes

Session: 234. Infections in Immunocompromised Individuals

Saturday, October 22, 2022: 12:15 PM

© The Author(s) 2022. Published by Oxford University Press on behalf of Infectious Diseases Society of America.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited.
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