CMV serostatus still has an important prognostic impact in de novo acute leukemia patients after allogeneic stem cell transplantation: a report from the Acute Leukemia Working Party of EBMT

• Published in: Blood Vol. 122; no. 19; pp. 3359 - 3364
• Main Authors: Schmidt-Hieber, Martin, Labopin, Myriam, Beelen, Dietrich, Volin, Liisa, Ehninger, Gerhard, Finke, Jürgen, Socié, Gerard, Schwerdtfeger, Rainer, Kröger, Nicolaus, Ganser, Arnold, Niederwieser, Dietger, Polge, Emmanuelle, Blau, Igor W., Mohty, Mohamad
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 07.11.2013
• Subjects: Adolescent; Adult; Aged; Antibodies, Viral - blood; Cytomegalovirus; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - immunology; Cytomegalovirus Infections - mortality; Cytomegalovirus Infections - virology; Female; Graft vs Host Disease - immunology; Graft vs Host Disease - mortality; Graft vs Host Disease - virology; Hematopoietic Stem Cell Transplantation; Humans; Leukemia, Myeloid, Acute - complications; Leukemia, Myeloid, Acute - immunology; Leukemia, Myeloid, Acute - mortality; Leukemia, Myeloid, Acute - virology; Male; Middle Aged; Multivariate Analysis; Precursor Cell Lymphoblastic Leukemia-Lymphoma - complications; Precursor Cell Lymphoblastic Leukemia-Lymphoma - immunology; Precursor Cell Lymphoblastic Leukemia-Lymphoma - mortality; Precursor Cell Lymphoblastic Leukemia-Lymphoma - virology; Prognosis; Recurrence; Survival Analysis; Tissue Donors; Transplantation, Homologous
• ISSN: 0006-4971; 1528-0020; 1528-0020
• DOI: 10.1182/blood-2013-05-499830

We analyzed the prognostic impact of donor and recipient cytomegalovirus (CMV) serostatus in 16 628 de novo acute leukemia patients after allogeneic stem cell transplantation (allo-SCT). Compared with CMV-seronegative recipients who underwent allograft from a CMV-seronegative donor, cases of CMV seropositivity of the donor and/or the recipient showed a significantly decreased 2-year leukemia-free survival (44% vs 49%, P < .001) and overall survival (50% vs 56%, P < .001), and increased nonrelapse mortality (23% vs 20%, P < .001). Both groups showed a comparable relapse incidence and 2-year probability of graft-versus-host disease. The negative prognostic effects of CMV seropositivity of the donor and/or the recipient (vs CMV seronegativity of both) were significantly stronger for acute lymphoblastic leukemia (ALL) than for acute myeloid leukemia (AML), resulting in a markedly reduced 2-year overall survival (46% vs 55% for ALL compared with 52% vs 56% for AML). The important prognostic impact of donor/recipient CMV serostatus remained in a multivariate Cox regression analysis including the other prognostic variables. We conclude that donor and/or recipient CMV seropositivity is still associated with an adverse prognosis in de novo acute leukemia patients after allo-SCT despite the implementation of sophisticated strategies for prophylaxis, monitoring, and (preemptive) treatment of CMV. •Donor and/or recipient CMV seropositivity is still associated with an adverse prognosis in de novo acute leukemia patients after allo-SCT.