AI Article Synopsis
- CMV is a major concern for patients undergoing allogeneic hematopoietic stem cell transplantation (AHSCT), with existing prevention methods having their own risks and costs.
- A study of 185 AHSCT patients revealed that, despite high donor and recipient seropositivity, the CMV reactivation rate was lower than expected at 24.9%, and factors like underlying disease or treatment regimen didn't significantly impact this rate.
- The presence of graft-versus-host disease (GVHD) and certain HLA antigens were associated with higher reactivation rates, indicating a need for tailored risk assessment and management strategies based on genetic factors.
Article Abstract
Objective: Cytomegalovirus (CMV) is a significant cause of morbidity and mortality in allogeneic hematopoietic stem cell transplantation (AHSCT) recipients. Current practice includes prophylactic and preemptive treatment modalities, which have risks, side effects, and costs of their own. There is no established risk scoring system that applies to all patients. We aimed to investigate the risk factors for CMV reactivation in AHSCT recipients.
Materials And Methods: We retrospectively analyzed the risk factors for CMV reactivation in 185 consequent AHSCT recipients transplanted between September 2003 and December 2009 at the Stem Cell Transplantation Unit of Gazi University. Besides the standard transplant-related parameters, HLA antigens were also included among the variables analyzed.
Results: Despite the very high rate of donor (94.6%) and recipient (100%) seropositivity, which are the so-called major risk factors in previous reports, our reactivation rate was much lower, with a frequency of 24.9%. The underlying disease, sex, conditioning regimen, and presence of antithymocyte globulin or fludarabine in the conditioning regimen had no impact on reactivation rate. CMV reactivation was significantly more frequent in recipients with graft-versus-host disease (GVHD) compared to those without GVHD (p<0.0001). CMV reactivation was significantly more frequent (p<0.05) in patients with HLA-B14, HLA-DRB1*01, and HLA-DRB1*13 antigens and less frequent in recipients with HLA-A11 and HLA-DRB1*04 antigens (p<0.05).
Conclusion: Universal risk factors/scores that apply to all transplant recipients are required for tailored prophylaxis and/or treatment strategies for CMV reactivation. Uncovering the role of genetic factors, including HLA antigens, as possible risk factors might lead the way to risk-adaptive strategies for adoptive cellular therapy and/or vaccination.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4287029 | PMC |
| http://dx.doi.org/10.4274/tjh.2013.0244 | DOI Listing |
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