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Scoring system for clinically significant CMV infection in seropositive recipients following allogenic hematopoietic cell transplant: an SFGM-TC study

Bone Marrow Transplantation volume 56, pages 1305–1315 (2021)Cite this article

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Abstract

In order to identify cytomegalovirus (CMV)-seropositive patients who are at risk of developing CMV infection following first allogeneic hematopoietic cell transplantation (allo-HCT), we built up a scoring system based on patient/donor characteristics and transplantation modalities. To this end, 3690 consecutive patients were chronologically divided into a derivation cohort (2010–2012, n = 2180) and a validation cohort (2013–2014, n = 1490). Haploidentical donors were excluded. The incidence of first clinically significant CMV infection (CMV disease or CMV viremia leading to preemptive treatment) at 1, 3, and 6 months in the derivation cohort was 13.8%, 38.5%, and 39.6%, respectively. CMV-seropositive donor, unrelated donor (HLA matched 10/10 or HLA mismatched 9/10), myeloablative conditioning, total body irradiation, antithymocyte globulin, and mycophenolate mofetil significantly and independently affected the incidence of 3-month infection. These six factors were selected to build up the prognostic model. Four risk groups were defined: low, intermediate-low, intermediate-high, and high-risk categories, with a 3-month predicted incidence of first clinically significant CMV infection in the derivation cohort of 22.2%, 31.1%, 45.4%, and 56.9%, respectively. This score represents a framework for the evaluation of patients who are at risk of developing clinically significant CMV infection following allo-HCT. Prospective studies using this score may be of benefit in assessing the value of anti-CMV prophylaxis in well-defined patient cohorts.

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Fig. 1: Flowchart of the patient selection process for the derivation and validation cohorts.
Fig. 2: Observed and predicted cumulative incidence curves for the first clinically significant CMV infection in the derivation cohort.

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Acknowledgements

The authors would like to thank Nicole Raus, the SFGM-TC data manager. The authors wish to acknowledge all our medical teams for their dedication and involvement in daily patient care. A special thanks to Dr. Martine Lenoble for her help in writing and proofreading this article.

Funding

This study was supported in part by a research grant from Biotest.

Author information

Authors and Affiliations

  1. Department of Hematology, Univ. Lille, CHU Lille, F-59000, Lille, France

    David Beauvais & Ibrahim Yakoub-Agha

  2. ULR 2694—METRICS: Évaluation des technologies de santé et des pratiques médicales, Univ Lille, CHU Lille, F-59000, Lille, France

    Elodie Drumez & Alain Duhamel

  3. Department of Biostatistics, CHU Lille, F-59000, Lille, France

    Elodie Drumez & Alain Duhamel

  4. Department of Hematology, Institut Paoli Calmettes, Marseille, France

    Didier Blaise

  5. Hematology Transplant Unit, AP-HP, Hôpital Saint-Louis, Paris, France

    Régis Peffault de Latour

  6. Service d’hematologie et therapie cellulaire, CHU Bordeaux, F-33000, Bordeaux, France

    Edouard Forcade

  7. Hematology Department, Saint-Eloi University Hospital, Montpellier, France

    Patrice Ceballos

  8. Department of Oncology, KU Leuven, Leuven, Belgium

    Anne Uyttebroeck

  9. Department of Hematology, Hospices Civils de Lyon, Hôpital Lyon-Sud, Pierre-Bénite, France

    Hélène Labussière

  10. Department of Hematology, AP-HP, Hôpital Pitié-Salpétrière, Paris, France

    Stéphanie Nguyen

  11. Department of Hematology and Stem Cell Transplantation, Institut Gustave Roussy, Villejuif, France

    Jean-Henri Bourhis

  12. Department of Hematology, University Hospital, Nantes, France

    Patrice Chevallier

  13. Hematology Department, CHU Grenoble, Grenoble, France

    Anne Thiebaut

  14. Section of Hematology, Cliniques Universitaires St-Luc, Brussels, Belgium

    Xavier Poiré

  15. Hematology Department, AP-HP, Hôpital Henri-Mondor, Créteil, France

    Sébastien Maury

  16. Hematology Department, University Hospital, Besançon, France

    Eric Deconinck

  17. Service d’Hématologie Clinique, CHU de Nice, Nice, France

    Thomas Cluzeau

  18. Department of Hematology, Saint-Antoine University Hospital, Paris, France

    Eolia Brissot

  19. CHU—Institut Universitaire du Cancer Toulouse Oncopole (IUCT-O), Toulouse, France

    Anne Huynh

  20. University Hospital of Nancy, Vandoeuvre-Les-Nancy, France

    Marie-Thérèse Rubio

  21. Univ Lille, CHU Lille, Inserm U1286, Infinite, F-59000, Lille, France

    Ibrahim Yakoub-Agha

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  1. David Beauvais
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  2. Elodie Drumez
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  21. Ibrahim Yakoub-Agha
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Contributions

DB, ED, AD, and IY-A designed the study, reviewed the data, analyzed results, and made the figures. All authors wrote and approved the manuscript.

Corresponding author

Correspondence to Ibrahim Yakoub-Agha.

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Conflict of interest

IY-A received honorarium from MSD and Biotest, both are selling anti-CMV drugs. The other authors have no conflicts of interest to declare.

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Beauvais, D., Drumez, E., Blaise, D. et al. Scoring system for clinically significant CMV infection in seropositive recipients following allogenic hematopoietic cell transplant: an SFGM-TC study. Bone Marrow Transplant 56, 1305–1315 (2021). https://doi.org/10.1038/s41409-020-01178-6

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  • DOI: https://doi.org/10.1038/s41409-020-01178-6

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