Effect of Cytomegalovirus Reactivation With or Without Acute Graft-Versus-Host Disease on the Risk of Nonrelapse Mortality

Author:

Akahoshi Yu1ORCID,Kimura Shun-Ichi1,Inamoto Yoshihiro2,Seo Sachiko3,Muranushi Hiroyuki4,Shimizu Hiroaki5,Ozawa Yukiyasu6,Tanaka Masatsugu7,Uchida Naoyuki8,Kanda Yoshinobu19,Katayama Yuta10,Shiratori Souichi11,Ota Shuichi12,Matsuoka Ken-ichi13,Onizuka Makoto14,Fukuda Takahiro2,Atsuta Yoshiko1516,Murata Makoto17,Terakura Seitaro17,Nakasone Hideki1

Affiliation:

1. Division of Hematology, Jichi Medical University Saitama Medical Center, Saitama, Japan

2. Division of Hematopoietic Stem Cell Transplantation, National Cancer Center Hospital, Tokyo, Japan

3. Department of Haematology and Oncology, Dokkyo Medical University, Tochigi, Japan

4. Department of Hematology and Oncology, Graduate School of Medicine, Kyoto University, Kyoto, Japan

5. Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan

6. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

7. Department of Hematology, Kanagawa Cancer Center, Yokohama, Japan

8. Department of Hematology, Federation of National Public Service Personnel Mutual Aid Associations Toranomon Hospital, Tokyo, Japan

9. Division of Hematology, Department of Medicine, Jichi Medical University, Tochigi, Japan

10. Department of Hematology, Hiroshima Red Cross Hospital and Atomic Bomb Survivors Hospital, Hiroshima, Japan

11. Department of Hematology, Hokkaido University Faculty of Medicine, Sapporo, Japan

12. Department of Hematology, Sapporo Hokuyu Hospital, Sapporo, Japan

13. Department of Hematology and Oncology, Okayama University Hospital, Okayama, Japan

14. Department of Hematology and Oncology, Tokai University School of Medicine, Kanagawa, Japan

15. Japanese Data Center for Hematopoietic Cell Transplantation, Nagoya, Japan

16. Department of Healthcare Administration, Nagoya University Graduate School of Medicine, Nagoya, Japan

17. Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan

Abstract

Abstract Background Despite a strong association between acute graft-versus-host disease (GVHD) and cytomegalovirus reactivation (CMVR), the joint effect of acute GVHD and CMVR on nonrelapse mortality (NRM) has not been well studied. Methods We evaluated the impact of CMVR on NRM stratified according to the development of acute GVHD using a landmark method. This study included 6078 patients who received their first allogeneic hematopoietic cell transplantation (HCT) with a preemptive strategy for CMVR between 2008 and 2017. Results The cumulative incidences of grade 2-4 acute GVHD (G24GVHD), CMVR by day 100, and CMV disease by day 365 were 37.3%, 52.1%, and 2.9%, respectively. Patients with G24GVHD were associated with the subsequent development of CMVR, and the presence of CMVR also increased the risk of G24GVHD. In a landmark analysis at day 65, the cumulative incidence of NRM at 1 year was 5.4%, 10.0%, 13.9%, and 19.7% in patients with G24GVHD–/CMVR–, G24GVHD–/CMVR+, G24GVHD+/CMVR–, and G24GVHD+/CMVR+, respectively. In a multivariate analysis, CMVR was respectively associated with an increased risk of NRM by day 365 in patients without G24GVHD (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.24–2.05; P < .001) and with G24GVHD (HR, 1.34; 95% CI, 1.06–1.70; P = .014), but the interaction between G24GVHD and CMVR was not significant (P = .326). Subgroup analyses suggested that the joint effect of acute GVHD and CMVR might vary according to the baseline characteristics. Conclusions These data regarding the close relationship between acute GVHD and CMVR should provide important implications for the treatment strategy after HCT.

Funder

Japan Society for the Promotion of Science

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3