|Prediction of CMV reactivation by recipient CMV-IgG titer before allo-HCT.|
Kawamura S, Nakasone H, Takeshita J, Kimura SI, Nakamura Y, Kawamura M, Misaki NY, Yoshimura K, Matsumi S, Gomyo A, Akahoshi Y, Kusuda M, Kameda K, Tanihara A, Tamaki M, Kako S, Kanda Y.
Transplantation and cellular therapy. 2021; ():
BACKGROUND: Recipient cytomegalovirus (CMV) seropositivity is known to be a risk factor for CMV reactivation after allogeneic hematopoietic stem cell transplantation (allo-HCT). OBJECTIVE: We explored the association of CMV-IgG titer of recipients with CMV reactivation after allo-HCT and aimed to establish a model for predicting CMV reactivation for the purpose of identifying a high-risk group. In addition, we evaluated the impact of CMV-IgG titer on survival outcomes and acute graft-versus-host-disease (GVHD). STUDY DESIGN: We retrospectively analyzed 309 patients who achieved neutrophil engraftment after allo-HCT, and evaluated whether pre-transplant recipient CMV-IgG titer was associated with transplant outcomes including CMV reactivation. Using the best cut-off value determined by a receiver operating characteristics (ROC) curve analysis, we divided cohorts into three groups, "High-titer", "Low-titer" and "Negative" groups. RESULTS: CMV reactivation frequently occurred in the "High-titer" group, followed by the "Low-titer" and "Negative-titer" groups [81%, 37% vs. 16% at 180 days after allo-HCT, P<0.01]. In a multivariate analysis, recipient CMV-IgG titer was significantly associated with subsequent CMV reactivation [HR 9.31 in the "High-titer" group, P<0.01; HR 2.91 in the "Low-titer" group, P=0.023]. CMV diseases were exclusively observed in the "High-titer" group. Overall survival (OS) in the "High-titer" group tended to be lower than those in the other two groups [2-year OS 56%, 60% vs. 80%, P=0.075], while the cumulative incidences of grade 2-4 acute graft-versus-host disease (GVHD), non-relapse mortality (NRM) and relapse were not significantly different among the three groups. In multivariate analyses, CMV-IgG titer was not associated with increased risks of these outcomes, although CMV reactivation itself was identified as a risk factor of NRM [HR 3.05, P=0.002]. CONCLUSION: We demonstrated that a higher titer of recipient CMV-IgG would predict CMV reactivation after allo-HCT. Further investigation will be required to determine how to apply these results to prophylactic or preemptive strategies against CMV, considering recipient CMV-IgG titer for effective risk stratification. CI - Copyright (c) 2021. Published by Elsevier Inc.