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A risk score for early cytomegalovirus reactivation after allogeneic stem cell transplantation identifies low‐, intermediate‐, and high‐risk groups: reactivation risk is increased by graft‐versus‐host disease only in the intermediate‐risk group
Author(s) -
George B.,
Kerridge I.H.,
Gilroy N.,
Huang G.,
Hertzberg M.S.,
Bradstock K.F.,
Gottlieb D.J.
Publication year - 2012
Publication title -
transplant infectious disease
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.69
H-Index - 67
eISSN - 1399-3062
pISSN - 1398-2273
DOI - 10.1111/j.1399-3062.2011.00706.x
Subject(s) - medicine , transplantation , hematopoietic stem cell transplantation , framingham risk score , alemtuzumab , logistic regression , graft versus host disease , risk factor , cytomegalovirus , disease , immunology , viral disease , virus , herpesviridae
Background This retrospective study was aimed at establishing a clinical score to stratify the risk of cytomegalovirus ( CMV ) reactivation in patients undergoing allogeneic hematopoietic stem cell transplantation ( HSCT ) in order to direct strategies for post‐transplant CMV monitoring and therapy. Patients and methods In total, 335 adult patients undergoing HSCT were analyzed and divided into a training set ( n = 235) and a validation set ( n = 100). Logistic regression analysis on the training set identified recipient and donor CMV seropositivity, acute graft‐versus‐host disease ( GVHD ), and use of anti‐thymocyte globulin or alemtuzumab as significant risk factors for CMV reactivation. Weighted scores were assigned to each factor. A weighted score ( CMV scoring index [ CSI ]) was calculated for each patient using the scores of all risk factors except for GVHD . The index was collapsed into 3 risk groups – low risk (score of 0–2), intermediate risk (score of 3–5), and high risk (score of 6–7) – and reactivation rates were calculated. In the training set, CMV reactivation occurred in 5.8% in the low‐risk group, 44.8% in the intermediate‐risk group, and 67.7% in the high‐risk group. Results In patients with an intermediate CSI only, significantly higher reactivation rates were seen in the presence of corticosteroid treatment for GVHD (57.8% vs. 24.5%, P < 0.01). These findings were similar in the validation set with reactivation rates of 0% in the low‐risk, 46% in the intermediate‐risk, and 68.4% in the high‐risk groups. As seen in the training set, the presence of GVHD was associated with higher CMV reactivation rates only in the intermediate‐risk group (64% vs. 28% in the absence of GVHD , P = 0.02). Conclusions Identification of these 3 risk groups in association with the presence or absence of GVHD will help transplant units to make pre‐transplant policy decisions about prophylactic, pre‐emptive, or experimental CMV prevention strategies in groups of patients undergoing HSCT , as well as in those developing GVHD post transplant.