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CMV reactivation after allogeneic HCT is associated with a reduced risk of relapse in acute lymphoblastic leukemia

Cytomegalovirus reactivation (CMVR) after allogeneic hematopoietic cell transplantation (HCT) is a frequent complication related to survival outcomes; however, its impact on relapse remains unclear, especially in acute lymphoblastic leukemia (ALL). In this nationwide retrospective study, we included...

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Autores principales: Akahoshi, Yu, Nakasone, Hideki, Takenaka, Katsuto, Yamasaki, Satoshi, Nakamura, Momoko, Doki, Noriko, Tanaka, Masatsugu, Ozawa, Yukiyasu, Uchida, Naoyuki, Ara, Takahide, Nakamae, Hirohisa, Ota, Shuichi, Onizuka, Makoto, Yano, Shingo, Tanaka, Junji, Fukuda, Takahiro, Kanda, Yoshinobu, Atsuta, Yoshiko, Kako, Shinichi, Yanada, Masamitsu, Arai, Yasuyuki
Formato: Online Artículo Texto
Lenguaje:English
Publicado: The American Society of Hematology 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333743/
https://www.ncbi.nlm.nih.gov/pubmed/36661335
http://dx.doi.org/10.1182/bloodadvances.2022009376
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author Akahoshi, Yu
Nakasone, Hideki
Takenaka, Katsuto
Yamasaki, Satoshi
Nakamura, Momoko
Doki, Noriko
Tanaka, Masatsugu
Ozawa, Yukiyasu
Uchida, Naoyuki
Ara, Takahide
Nakamae, Hirohisa
Ota, Shuichi
Onizuka, Makoto
Yano, Shingo
Tanaka, Junji
Fukuda, Takahiro
Kanda, Yoshinobu
Atsuta, Yoshiko
Kako, Shinichi
Yanada, Masamitsu
Arai, Yasuyuki
author_facet Akahoshi, Yu
Nakasone, Hideki
Takenaka, Katsuto
Yamasaki, Satoshi
Nakamura, Momoko
Doki, Noriko
Tanaka, Masatsugu
Ozawa, Yukiyasu
Uchida, Naoyuki
Ara, Takahide
Nakamae, Hirohisa
Ota, Shuichi
Onizuka, Makoto
Yano, Shingo
Tanaka, Junji
Fukuda, Takahiro
Kanda, Yoshinobu
Atsuta, Yoshiko
Kako, Shinichi
Yanada, Masamitsu
Arai, Yasuyuki
author_sort Akahoshi, Yu
collection PubMed
description Cytomegalovirus reactivation (CMVR) after allogeneic hematopoietic cell transplantation (HCT) is a frequent complication related to survival outcomes; however, its impact on relapse remains unclear, especially in acute lymphoblastic leukemia (ALL). In this nationwide retrospective study, we included patients with acute myeloid leukemia (AML) and ALL in the first or second complete remission who underwent their first HCT using a pre-emptive strategy for CMVR. Because 90% of cases with CMVR had occurred by day 64 and 90% of cases with grades 2 to 4 acute graft-versus-host disease (GVHD) had occurred by day 58, a landmark point was set at day 65. In landmark analyses, 3793 patients with AML and 2213 patients with ALL who survived without relapse for at least 65 days were analyzed. Multivariate analyses showed that CMVR was associated with a lower incidence of relapse in both AML (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.69-0.95; P = .009) and ALL (HR, 0.81; 95% CI, 0.66-0.99; P = .045). These findings were confirmed when CMVR was used as the time-dependent covariate. Moreover, our study suggests that the protective effect of CMVR on relapse was independent of acute GVHD. A post-hoc subgroup analysis of combined AML and ALL showed that CMVR had a mild antileukemia effect without effect modification, in contrast to the impact of CMVR on NRM. Our findings may provide important implications for strategies used for CMV prophylaxis after HCT.
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spelling pubmed-103337432023-07-12 CMV reactivation after allogeneic HCT is associated with a reduced risk of relapse in acute lymphoblastic leukemia Akahoshi, Yu Nakasone, Hideki Takenaka, Katsuto Yamasaki, Satoshi Nakamura, Momoko Doki, Noriko Tanaka, Masatsugu Ozawa, Yukiyasu Uchida, Naoyuki Ara, Takahide Nakamae, Hirohisa Ota, Shuichi Onizuka, Makoto Yano, Shingo Tanaka, Junji Fukuda, Takahiro Kanda, Yoshinobu Atsuta, Yoshiko Kako, Shinichi Yanada, Masamitsu Arai, Yasuyuki Blood Adv Transplantation Cytomegalovirus reactivation (CMVR) after allogeneic hematopoietic cell transplantation (HCT) is a frequent complication related to survival outcomes; however, its impact on relapse remains unclear, especially in acute lymphoblastic leukemia (ALL). In this nationwide retrospective study, we included patients with acute myeloid leukemia (AML) and ALL in the first or second complete remission who underwent their first HCT using a pre-emptive strategy for CMVR. Because 90% of cases with CMVR had occurred by day 64 and 90% of cases with grades 2 to 4 acute graft-versus-host disease (GVHD) had occurred by day 58, a landmark point was set at day 65. In landmark analyses, 3793 patients with AML and 2213 patients with ALL who survived without relapse for at least 65 days were analyzed. Multivariate analyses showed that CMVR was associated with a lower incidence of relapse in both AML (hazard ratio [HR], 0.81; 95% confidence interval [CI], 0.69-0.95; P = .009) and ALL (HR, 0.81; 95% CI, 0.66-0.99; P = .045). These findings were confirmed when CMVR was used as the time-dependent covariate. Moreover, our study suggests that the protective effect of CMVR on relapse was independent of acute GVHD. A post-hoc subgroup analysis of combined AML and ALL showed that CMVR had a mild antileukemia effect without effect modification, in contrast to the impact of CMVR on NRM. Our findings may provide important implications for strategies used for CMV prophylaxis after HCT. The American Society of Hematology 2023-01-24 /pmc/articles/PMC10333743/ /pubmed/36661335 http://dx.doi.org/10.1182/bloodadvances.2022009376 Text en © 2023 by The American Society of Hematology. Licensed under Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0), permitting only noncommercial, nonderivative use with attribution. All other rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Transplantation
Akahoshi, Yu
Nakasone, Hideki
Takenaka, Katsuto
Yamasaki, Satoshi
Nakamura, Momoko
Doki, Noriko
Tanaka, Masatsugu
Ozawa, Yukiyasu
Uchida, Naoyuki
Ara, Takahide
Nakamae, Hirohisa
Ota, Shuichi
Onizuka, Makoto
Yano, Shingo
Tanaka, Junji
Fukuda, Takahiro
Kanda, Yoshinobu
Atsuta, Yoshiko
Kako, Shinichi
Yanada, Masamitsu
Arai, Yasuyuki
CMV reactivation after allogeneic HCT is associated with a reduced risk of relapse in acute lymphoblastic leukemia
title CMV reactivation after allogeneic HCT is associated with a reduced risk of relapse in acute lymphoblastic leukemia
title_full CMV reactivation after allogeneic HCT is associated with a reduced risk of relapse in acute lymphoblastic leukemia
title_fullStr CMV reactivation after allogeneic HCT is associated with a reduced risk of relapse in acute lymphoblastic leukemia
title_full_unstemmed CMV reactivation after allogeneic HCT is associated with a reduced risk of relapse in acute lymphoblastic leukemia
title_short CMV reactivation after allogeneic HCT is associated with a reduced risk of relapse in acute lymphoblastic leukemia
title_sort cmv reactivation after allogeneic hct is associated with a reduced risk of relapse in acute lymphoblastic leukemia
topic Transplantation
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10333743/
https://www.ncbi.nlm.nih.gov/pubmed/36661335
http://dx.doi.org/10.1182/bloodadvances.2022009376
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