In:
Blood Advances, American Society of Hematology, Vol. 6, No. 2 ( 2022-01-25), p. 574-584
Abstract:
A preemptive strategy has successfully decreased cytomegalovirus (CMV) disease after allogeneic hematopoietic cell transplantation (HCT). However, some recipients still develop CMV gastroenteritis, especially after acute graft-versus-host disease (aGVHD), and its incidence, risk factors, and prognostic impact remain to be elucidated. We retrospectively analyzed 3759 consecutive adult patients who developed grade II-IV aGVHD using a Japanese registry database. The cumulative incidence of CMV gastroenteritis was 5.7% by day 365 from the development of grade II-IV aGVHD. Advanced age (hazard ratio [HR], 1.60; 95% confidence interval [CI] , 1.16-2.22; P = .004), GVHD prophylaxis with mycophenolate mofetil and calcineurin inhibitor (HR, 1.73; 95% CI, 1.08-2.77; P = .024), lower-gut aGVHD (HR, 2.17; 95% CI, 1.58-2.98; P & lt; .001), and the use of systemic steroids (HR, 1.78; 95% CI, 1.16-2.74; P = .008) were independent risk factors for CMV gastroenteritis. Development of CMV gastroenteritis was associated with an increased risk of nonrelapse mortality (HR, 1.89; 95% CI, 1.50-2.39; P & lt; .001). Moreover, letermovir prophylaxis significantly reduced both the incidence of CMV gastroenteritis (HR, 0.50; 95% CI, 0.25-0.99; P = .047) and the risk of nonrelapse mortality (HR, 0.72; 95% CI, 0.52-0.99; P = .043). In summary, CMV gastroenteritis is a life-threatening complication that sets the need for preventive strategies with letermovir and targeted surveillance.
Type of Medium:
Online Resource
ISSN:
2473-9529
,
2473-9537
DOI:
10.1182/bloodadvances.2021005885
Language:
English
Publisher:
American Society of Hematology
Publication Date:
2022
detail.hit.zdb_id:
2876449-3
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