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Cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: Pattern, survival, and risk factors in the Republic of Korea

INTRODUCTION: Pre-emptive therapy for cytomegalovirus (CMV) reactivation has been used in allogeneic hematopoietic stem cell transplantation (allo-HSCT). It is unclear if this strategy has poorer clinical outcomes in CMV-endemic areas and if more aggressive prophylaxis is required. METHODS: We retro...

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Autores principales: Kang, Ka-Won, Jeon, Min Ji, Yu, Eun Sang, Kim, Dae Sik, Lee, Byung-Hyun, Lee, Se Ryeon, Choi, Chul Won, Park, Yong, Kim, Byung Soo, Sung, Hwa Jung
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10499250/
https://www.ncbi.nlm.nih.gov/pubmed/37703263
http://dx.doi.org/10.1371/journal.pone.0291268
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author Kang, Ka-Won
Jeon, Min Ji
Yu, Eun Sang
Kim, Dae Sik
Lee, Byung-Hyun
Lee, Se Ryeon
Choi, Chul Won
Park, Yong
Kim, Byung Soo
Sung, Hwa Jung
author_facet Kang, Ka-Won
Jeon, Min Ji
Yu, Eun Sang
Kim, Dae Sik
Lee, Byung-Hyun
Lee, Se Ryeon
Choi, Chul Won
Park, Yong
Kim, Byung Soo
Sung, Hwa Jung
author_sort Kang, Ka-Won
collection PubMed
description INTRODUCTION: Pre-emptive therapy for cytomegalovirus (CMV) reactivation has been used in allogeneic hematopoietic stem cell transplantation (allo-HSCT). It is unclear if this strategy has poorer clinical outcomes in CMV-endemic areas and if more aggressive prophylaxis is required. METHODS: We retrospectively analyzed the patterns and survival after CMV reactivation in patients undergoing pre-emptive therapy following allo-HSCT and assessed high-risk patients who could benefit from aggressive CMV prophylaxis in endemic areas. RESULTS: Of the 292 patients who underwent allo-HSCT, 70.5% (donor+ or recipient+) were CMV seropositive. CMV reactivation occurred in 139 patients (47.6%), with a median of 31.5 days from day 0 of allo-HSCT. The overall survival of patients with CMV reactivation who received pre-emptive therapy did not differ from those without reactivation. Of the 139 patients with CMV reactivation, 78 (56.1%) underwent ≥2 rounds of pre-emptive therapy. In multivariate analysis, the risk of CMV reactivation was higher in patients with multiple myeloma, with CMV seropositivity of the recipient and donor, administered with a higher dose of anti-thymocyte globulin (ATG), and with acute graft-versus-host disease (aGVHD) ≥ grade 2. CONCLUSION: Although half of the patients with allo-HSCT were administered with pre-emptive therapy for CMV, CMV reactivation did not affect their survival, indicating the advantages of pre-emptive therapy, even in CMV-endemic areas. The cost-effectiveness of more aggressive CMV prophylaxis should be re-evaluated in patients at a high risk for CMV reactivation.
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spelling pubmed-104992502023-09-14 Cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: Pattern, survival, and risk factors in the Republic of Korea Kang, Ka-Won Jeon, Min Ji Yu, Eun Sang Kim, Dae Sik Lee, Byung-Hyun Lee, Se Ryeon Choi, Chul Won Park, Yong Kim, Byung Soo Sung, Hwa Jung PLoS One Research Article INTRODUCTION: Pre-emptive therapy for cytomegalovirus (CMV) reactivation has been used in allogeneic hematopoietic stem cell transplantation (allo-HSCT). It is unclear if this strategy has poorer clinical outcomes in CMV-endemic areas and if more aggressive prophylaxis is required. METHODS: We retrospectively analyzed the patterns and survival after CMV reactivation in patients undergoing pre-emptive therapy following allo-HSCT and assessed high-risk patients who could benefit from aggressive CMV prophylaxis in endemic areas. RESULTS: Of the 292 patients who underwent allo-HSCT, 70.5% (donor+ or recipient+) were CMV seropositive. CMV reactivation occurred in 139 patients (47.6%), with a median of 31.5 days from day 0 of allo-HSCT. The overall survival of patients with CMV reactivation who received pre-emptive therapy did not differ from those without reactivation. Of the 139 patients with CMV reactivation, 78 (56.1%) underwent ≥2 rounds of pre-emptive therapy. In multivariate analysis, the risk of CMV reactivation was higher in patients with multiple myeloma, with CMV seropositivity of the recipient and donor, administered with a higher dose of anti-thymocyte globulin (ATG), and with acute graft-versus-host disease (aGVHD) ≥ grade 2. CONCLUSION: Although half of the patients with allo-HSCT were administered with pre-emptive therapy for CMV, CMV reactivation did not affect their survival, indicating the advantages of pre-emptive therapy, even in CMV-endemic areas. The cost-effectiveness of more aggressive CMV prophylaxis should be re-evaluated in patients at a high risk for CMV reactivation. Public Library of Science 2023-09-13 /pmc/articles/PMC10499250/ /pubmed/37703263 http://dx.doi.org/10.1371/journal.pone.0291268 Text en © 2023 Kang et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Kang, Ka-Won
Jeon, Min Ji
Yu, Eun Sang
Kim, Dae Sik
Lee, Byung-Hyun
Lee, Se Ryeon
Choi, Chul Won
Park, Yong
Kim, Byung Soo
Sung, Hwa Jung
Cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: Pattern, survival, and risk factors in the Republic of Korea
title Cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: Pattern, survival, and risk factors in the Republic of Korea
title_full Cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: Pattern, survival, and risk factors in the Republic of Korea
title_fullStr Cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: Pattern, survival, and risk factors in the Republic of Korea
title_full_unstemmed Cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: Pattern, survival, and risk factors in the Republic of Korea
title_short Cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: Pattern, survival, and risk factors in the Republic of Korea
title_sort cytomegalovirus reactivation under pre-emptive therapy following allogeneic hematopoietic stem cell transplant: pattern, survival, and risk factors in the republic of korea
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10499250/
https://www.ncbi.nlm.nih.gov/pubmed/37703263
http://dx.doi.org/10.1371/journal.pone.0291268
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