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Pre-engraftment cytomegalovirus DNAemia in allogeneic hematopoietic stem cell transplant recipients: incidence, risk factors, and clinical outcomes

Bone Marrow Transplantation (2018) | Download Citation

Abstract

To gauge the risk of delaying initiation of prophylaxis with letermovir from the time of donor infusion to prevent CMV infection in allo-HSCT recipients we investigated the clinical outcomes of CMV DNAemia episodes occurring before engraftment, and compared to that of episodes developing after engraftment (up to day +365). A total of 197 consecutive adult patients were included. Plasma CMV DNA load was monitored by real-time PCR assays [limit of detection: 31 IU/ml]. A total of 150 out of 197 patients had CMV DNAemia (cumulative incidence of 77%; 95% CI, 73–81%), and 38 out of the 197 patients developed it before engraftment (cumulative incidence, 19%; 95% CI, 10–30.3%). Nine episodes of CMV DNAemia were detected prior to the time of donor progenitor cell infusion. A greater number of post-engraftment episodes required preemptive antiviral therapy compared with pre-engraftment episodes (62.5% vs 44.7%; P = 0.05). The cellular content of the donor progenitor cell infusion and transplant characteristics of patients did not differ between patients with pre-engraftment or post-engraftment CMV DNAemia. The cumulative incidence of overall mortality by days 100 and 365, aGvHD by day 100 and relapse by day 365 were not significantly different between patients with pre-engraftment or post-engraftment CMV DNAemia.

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Acknowledgements

Estela Giménez holds a Río Hortega research contract from the Carlos III Health Institute (Ref. CM16/00200). This research was supported by grants (12/1992 and 15/0060) from FIS (Fondo de Investigaciones Sanitarias, Ministerio de Sanidad y Consumo, Spain).

Author information

Author notes

  1. These authors contributed equally: Carlos Solano, Estela Giménez.

Affiliations

  1. Hematology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain

    • Carlos Solano
    • , Montserrat Gómez
    • , Rosa Goterris
    • , Ariadna Pérez
    • , Paula Amat
    • , Juan Carlos Hernández-Boluda
    • , Marc Poch
    •  & José Luis Piñana
  2. Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain

    • Carlos Solano
  3. Microbiology Service, Hospital Clínico Universitario, INCLIVA Research Institute, Valencia, Spain

    • Estela Giménez
    • , Eliseo Albert
    •  & David Navarro
  4. Microbiology Department, School of Medicine, University of Valencia, Valencia, Spain

    • Eva María Mateo
    •  & David Navarro

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The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to David Navarro.

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DOI

https://doi.org/10.1038/s41409-018-0251-0