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Haploidentical allogeneic hematopoietic stem cell transplantation increases the risk of cytomegalovirus infection in adult patients with acute leukemia
Author(s) -
Lin ChengHsien,
Su YiJiun,
Hsu ChiannYi,
Wang PoNan,
Teng ChiehLin Jerry
Publication year - 2019
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/tid.13096
Subject(s) - medicine , hematopoietic stem cell transplantation , leukemia , transplantation , cytomegalovirus , cytomegalovirus infection , stem cell , immunology , cytomegalovirus infections , acute leukemia , haematopoiesis , hematopoietic cell , oncology , human cytomegalovirus , human immunodeficiency virus (hiv) , viral disease , virus , herpesviridae , biology , genetics
Background Owing to the shortage of hematopoietic stem cells from matched sibling donors (MSD) and matched unrelated donors (MUD), the number of patients undergoing haploidentical allogeneic hematopoietic stem cell transplantation (allo‐HSCT) has rapidly increased. Despite a comparable overall survival (OS) and leukemia‐free survival using this approach, some evidence suggests that haploidentical allo‐HSCT recipients have a higher incidence of cytomegalovirus (CMV) infection, though this has not been clearly established. Methods This study retrospectively compared the cumulative incidence of CMV DNAemia, 2‐year OS, and leukemia‐free survival rates in acute leukemia patients with MSD (n = 41), MUD (n = 18), and haploidentical donor allografts (n = 21). Results The cumulative incidences of CMV DNAemia at day 180 in the MSD, MUD, and haploidentical groups were 39.0, 55.6, and 85.7%, respectively ( P < 0.000). As less than 50% of patients in the MSD group were detected to have CMV DNAemia, the median time to CMV DNAemia detection in patients allografted with MSD could not be obtained. However, it was 42 and 29 days, respectively, for the MUD and haploidentical groups. Multivariate analysis revealed that haploidentical allo‐HSCT (MSD vs. haploidentical: HR: 0.26; 95% CI: 0.09‐0.78; P = 0.017) and age (HR: 1.03; 95% CI: 1.01‐1.06; P = 0.011) increased CMV infection. Finally, MSD, MUD, and haploidentical allo‐HSCT provided comparable 2‐year OS rates (52.1%, 65.5%, and 65.6%; P = 0.425) and 2‐year leukemia‐free survival rates (67.1%, 68.3%, and 80.7%, P = 0.837). Conclusion The CMV incidence was higher for haploidentical allo‐HSCT than for MSD and MUD allo‐HSCT; this could be explained by graft‐versus‐host disease prophylaxis by multiple immunosuppressants.