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Bone Marrow Transplant. 2016 Aug;51(8):1113-20. doi: 10.1038/bmt.2016.89. Epub 2016 Apr 4.

Impact of early CMV reactivation in cord blood stem cell recipients in the current era.

Author information

1
Division of Hematology and Oncology, Department of Medicine, UMass Memorial Medical Center, Worcester, MA, USA.
2
Sainte Justine Hospital, University of Montreal, Montreal, Canada.
3
Hematology Branch, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
4
CIBMTR (Center for International Blood and Marrow Transplant Research), Department of Medicine, Medical College of Wisconsin, Milwaukee, WI, USA.
5
Division of Biostatistics, Institute for Health and Society, Medical College of Wisconsin, Milwaukee, WI, USA.
6
Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
7
Medical Director, Cleveland Cord Blood Center, Cleveland, OH, USA.
8
Seidman Cancer Center, University Hospitals Case Medical Center, Cleveland, OH, USA.
9
Pediatric Bone Marrow Transplant, University Hospitals Bristol NHS Trust, Bristol, UK.
10
Division of Hematology/Oncology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.
11
Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
12
Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA.
13
Department of Hematology and Medical Oncology, Winship Cancer Institute, Emory University, Atlanta, GA, USA.
14
Division of Hematology & Oncology, Department of Medicine, University of Florida, Gainesville, FL, USA.
15
Host Defense Program, Divisions of Hematology/Oncology/Bone Marrow Transplant and Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, USA.
16
Pediatric Blood and Marrow Transplantation Program, University Medical Center Utrecht, Utrecht, Netherlands.
17
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
18
Division of Hematology/Oncology, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.

Abstract

Several studies have reported an association between CMV reactivation and a decreased incidence of relapse for AML after adult donor allogeneic hematopoietic cell transplantation (HCT). Limited data, however, are available on the impact of CMV reactivation on relapse after cord blood (CB) stem cell transplantation. The unique combination of higher incidence of CMV reactivation in the seropositive recipient and lower incidence of graft versus host disease (GvHD) in CB HCT permits a valuable design to analyze the impact of CMV reactivation. Data from 1684 patients transplanted with CB between 2003 and 2010 for AML and ALL were analyzed. The median time to CMV reactivation was 34 days (range: 2-287). CMV reactivation and positive CMV serology were associated with increased non-relapse mortality (NRM) among both AML and ALL CB recipients (reactivation, AML: relative risk (RR) 1.41 (1.07-1.85); ALL: 1.60 (1.14-2.23); Serology, AML: RR 1.39 (1.05-1.85), ALL: RR 1.61 (1.18-2.19)). For patients with ALL, but not those with AML, this yielded inferior overall survival (P<0.005). Risk of relapse was not influenced by CMV reactivation or positive CMV serostatus for either disease.

PMID:
27042847
PMCID:
PMC4972682
DOI:
10.1038/bmt.2016.89
[Indexed for MEDLINE]
Free PMC Article

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