Hans Messner Allogeneic Transplant Program, Division of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University Health Network, Toronto, Ontario, Canada.
Department of Biostatistics, Princess Margaret Cancer Centre, University Health Network, Toronto, Canada.
Eur J Haematol. 2024 Oct;113(4):441-453. doi: 10.1111/ejh.14251. Epub 2024 Jun 16.
Cytomegalovirus (CMV) reactivation post-allogeneic hematopoietic cell transplantation (post-alloHCT) increases morbidity and mortality. We sought to determine the frequency of CMV seroconversion in patients pre-alloHCT and to investigate the impact on posttransplant outcomes. We retrospectively investigated 752 adult patients who underwent alloHCT at our center from January 2015 to February 2020 before the adoption of letermovir prophylaxis. CMV serology was assessed at consult and pretransplant. The cohort was divided into four groups based on pretransplant CMV seroconversion: negative to positive (Group 1), positive to negative (Group 2), consistently negative (Group 3), and consistently positive (Group 4). Eighty-nine patients (12%) had seroconverted from negative to positive, 17 (2%) from positive to negative, 151 (20%) were consistently seronegative, and 495 (66%) were consistently seropositive pretransplant. For the four CMV serostatus groups, cumulative incidence of CMV reactivation at 6 months posttransplant was 4.5%, 47.1%, 6.6%, and 76.6% for Groups 1, 2, 3, and 4, respectively (p < .0001). No differences between groups were seen regarding Grade III-IV acute graft-versus-host disease (GVHD) (p = .91), moderate/severe chronic GVHD (p = .41), or graft failure (p = .28). On multivariable analysis, there was no impact of CMV serostatus group on overall survival (p = .67), cumulative incidence of relapse (p = .83) or non-relapse mortality. alloHCT patients who demonstrate CMV seroconversion pretransplant from negative to positive have a very low risk of CMV reactivation posttransplant. The observed seroconversion may be due to passive CMV immunity acquired through blood products. Quantitative CMV immunoglobulin G/immunoglobulin M pretransplant may help differentiate between true seroconversion and passively transmitted CMV immunoglobulin.
巨细胞病毒（CMV）再激活在异基因造血细胞移植（alloHCT）后增加发病率和死亡率。我们试图确定患者在 alloHCT 前 CMV 血清转化的频率，并研究其对移植后结局的影响。我们回顾性调查了 2015 年 1 月至 2020 年 2 月在我们中心接受 alloHCT 的 752 例成年患者，这些患者在采用 letermovir 预防前进行了 CMV 血清学检查。在咨询和移植前评估 CMV 血清学。根据移植前 CMV 血清转化情况，将队列分为四组：从阴性到阳性（第 1 组），从阳性到阴性（第 2 组），持续阴性（第 3 组）和持续阳性（第 4 组）。89 例（12%）患者从阴性转为阳性，17 例（2%）从阳性转为阴性，151 例（20%）患者移植前持续阴性，495 例（66%）患者移植前持续阳性。对于 CMV 血清学的四组，移植后 6 个月的 CMV 再激活累积发生率分别为第 1、2、3 和 4 组的 4.5%、47.1%、6.6%和 76.6%（p < 0.0001）。各组之间在 III-IV 级急性移植物抗宿主病（GVHD）（p = 0.91）、中重度慢性 GVHD（p = 0.41）或移植物失败（p = 0.28）方面无差异。多变量分析显示，CMV 血清学状态组对总生存（p = 0.67）、复发累积发生率（p = 0.83）或非复发死亡率无影响。移植前从阴性转为阳性的 alloHCT 患者移植后发生 CMV 再激活的风险非常低。观察到的血清转化可能是由于通过血液制品获得的被动 CMV 免疫。移植前 CMV 免疫球蛋白 G/免疫球蛋白 M 的定量可能有助于区分真正的血清转化和被动传播的 CMV 免疫球蛋白。
