CMV serostatus has still an important prognostic impact in de novo acute leukemia patients after allogeneic stem cell transplantation: a report from the acute leukemia working party of EBMT

Martin Schmidt-Hieber, Myriam Labopin, Dietrich Beelen, Liisa Volin, Gerhard Ehninger, Jürgen Finke, Gerard Socié, Rainer Schwerdtfeger, Nicolaus Kröger, Arnold Ganser, Dietger Niederwieser, Emmanuelle Polge, Igor W Blau, Mohamad Mohty
Blood 2013 September 13
We analyzed the prognostic impact of donor and recipient cytomegalovirus (CMV) serostatus in 16628 de novo acute leukemia patients after allogeneic stem cell transplantation (allo-SCT). In comparison to CMV-seronegative recipients allografted from a CMV-seronegative donor, cases with CMV seropositivity of the donor and/or the recipient showed a significantly decreased 2-year leukemia-free survival (44% versus 49%, P < .001) and overall survival (50% versus 56%, P < .001), and increased non-relapse mortality (23% versus 20%, P < .001). Both groups showed a comparable relapse incidence and 2-year probability of graft-versus-host disease. The negative prognostic effects of CMV seropositivity of the donor and/or the recipient (versus CMV seronegativity of both) were significantly stronger for acute lymphoblastic leukemia (ALL) than for acute myeloid leukemia (AML), resulting in a markedly reduced 2-year overall survival (46% versus 55% for ALL compared to 52% versus 56% for AML). The important prognostic impact of donor/recipient CMV serostatus remained in a multivariate Cox regression analysis including the other prognostic variables. We conclude that donor and/or recipient CMV seropositivity is still associated with an adverse prognosis in de novo acute leukemia patients after allo-SCT despite the implementation of sophisticated strategies for prophylaxis, monitoring and (preemptive) treatment of CMV.

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