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Risk factors of clinically refractory CMV reactivation following allogeneic HSCT: a single-center study in China

Bone Marrow Transplantation volume 51, pages 1625–1627 (2016)Cite this article

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CMV reactivation remains the main cause of viral complications after allogeneic hematopoietic stem cell transplantation (aHSCT).1 In particular, CMV with gene mutations against antiviral drugs can lead to a high mortality rate.2 Nichols et al.3 reported that increased viral load happened in 39% of patients because of the latent immunosuppression after preemptive therapy. Moreover, PBSC transplantation (PBSCT) showed a faster immune recovery compared with bone marrow transplantation4, 5 and could reduce the risk of persistent CMV antigenemia and disease.6 It appears that drug resistance should be suspected in patients who had viral load increases for more than 2 weeks of antiviral therapy and the category and degree of host immunosuppression have great impact on drug resistance. Thus, a retrospective study was analyzed to explore the clinical risk factors and outcome for CMV reactivation and CMV clinically refractory to antiviral chemotherapy.

A total of 685 patients underwent aHSCT with a myeloablative conditioning regimen in the First Affiliated Hospital of Soochow University between January 2011 and 31 July 2014. The median time of follow-up was 16.7 months (range 1–46) through 30 April 2015. The characteristics of the patients are summarized in Table 1. GvHD prophylaxis consisted of cyclosporine and short term methotrexate, whereas patients with mismatched or unrelated donors also received mycophenolate mofetil as the part of GvHD prophylaxis. Meanwhile, 441 of all patients received antithymocyte globulin (ATG) as a component of GvHD prophylaxis. Degree and the treatment of acute GvHD (aGvHD) were executed according to the established categories and protocols.7, 8

Table 1 Characteristics of 685 patients
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Acknowledgements

This work was funded by Jiangsu Provincial Special Program of Medical Science (BL2012005); Jiangsu Province’s Key Medical Center (ZX201102) and the Priority Academic; Program Development of the Jiangsu Higher Education Institutions (PAPD); National clinical key subject project; National Natural Science Foundation of China (Grant No.81370626).

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  1. X Bao and Q Zhu: Co-first author

Authors and Affiliations

  1. Jiangsu Institute of Hematology, The First Affiliated Hospital of Soochow University, Suzhou, China

    X Bao, S Xue, Y Xu, X Ma, F Chen, X Hu, Z Zhu, S Chen, A Sun, D Wu & H Qiu

  2. Collaborative Innovation Center of Hematology, Soochow University, Suzhou, China

    X Bao, S Xue, Y Xu, X Ma, F Chen, X Hu, Z Zhu, S Chen, A Sun, D Wu & H Qiu

  3. Suzhou Institute of Blood and Marrow Transplantation, Suzhou, China

    X Bao, S Xue, Y Xu, X Ma, F Chen, X Hu, Z Zhu, S Chen, A Sun, D Wu & H Qiu

  4. Department of Hematology, 100th Hospital of People’s Liberation Army, Suzhou, China

    Q Zhu

  5. Cyrus Tang Hematology Center, Soochow University, Suzhou, China

    Y Song

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Correspondence to H Qiu.

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Bao, X., Zhu, Q., Xue, S. et al. Risk factors of clinically refractory CMV reactivation following allogeneic HSCT: a single-center study in China. Bone Marrow Transplant 51, 1625–1627 (2016). https://doi.org/10.1038/bmt.2016.231

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