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

• Authors: Muthalagu Ramanathan, UMass Memorial Medical Center; Pierre Teira, University of Montreal; Minoo Battiwalla, National Heart, Lung, and Blood Institute; John Barrett, National Heart, Lung, and Blood Institute; Kwang Woo Ahn, Medical College of Wisconsin; Min Chen, Medical College of Wisconsin; Jamie Green, University of Minnesota; Mary Laughlin, Cleveland Cord Blood Center; Hillard M. Lazarus, University Hospitals Case Medical Center; David Marks, University Hospitals Bristol NHS Trust; Ayman Saad, University of Alabama at Birmingham; Matthew Seftel, Princess Margaret Cancer Centre; Wael Saber, National Heart, Lung, and Blood Institute; Bipin Savani, Vanderbilt University; Edmund Waller, Emory University; John Wingard, University of Florida; Jeffery J. Auletta, Nationwide Children’s Hospital; Caroline A. Lindemans, University Medical Center Utrecht; Michael Boeckh, Fred Hutchinson Cancer Research Center; Marcie L. Riches, University of North Carolina at Chapel Hill
• Journal Title: Bone Marrow Transplantation
• Volume: Volume 51, Number 8
• Publisher: Nature Publishing Group: Open Access Hybrid Model Option B | 2016-08, Pages 1113-1120
• Type of Work: Article | Post-print: After Peer Review
• Publisher DOI: http://doi.org/10.1038/bmt.2016.89
• Subjects: Biology, Virology; Health Sciences, Oncology
• Keywords: Science & Technology; Life Sciences & Biomedicine; Biophysics; Oncology; Hematology; Immunology; Transplantation; ACUTE MYELOID-LEUKEMIA; RELAPSE RISK EVIDENCE; T-CELLS; BONE-MARROW; CYTOMEGALOVIRUS REACTIVATION; TRANSPLANT RECIPIENTS; ALLO-SCT; DONOR; DISEASE; SEROSTATUS; Cytomegalovirus; Umbilical cord blood; Allogeneic transplant; Leukemia

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.