TY - JOUR
T1 - Effect of Cytomegalovirus Reactivation with or Without Acute Graft-Versus-Host Disease on the Risk of Nonrelapse Mortality
AU - Akahoshi, Yu
AU - Kimura, Shun Ichi
AU - Inamoto, Yoshihiro
AU - Seo, Sachiko
AU - Muranushi, Hiroyuki
AU - Shimizu, Hiroaki
AU - Ozawa, Yukiyasu
AU - Tanaka, Masatsugu
AU - Uchida, Naoyuki
AU - Kanda, Yoshinobu
AU - Katayama, Yuta
AU - Shiratori, Souichi
AU - Ota, Shuichi
AU - Matsuoka, Ken Ichi
AU - Onizuka, Makoto
AU - Fukuda, Takahiro
AU - Atsuta, Yoshiko
AU - Murata, Makoto
AU - Terakura, Seitaro
AU - Nakasone, Hideki
N1 - Publisher Copyright:
© 2020
PY - 2021/8/1
Y1 - 2021/8/1
N2 - Background: Despite a strong association between acute graft-versus-host disease (GVHD) and cytomegalovirus reactivation (CMVR), the joint effect of acute GVHD and CMVR on nonrelapse mortality (NRM) has not been well studied. Methods: We evaluated the impact of CMVR on NRM stratified according to the development of acute GVHD using a landmark method. This study included 6078 patients who received their first allogeneic hematopoietic cell transplantation (HCT) with a preemptive strategy for CMVR between 2008 and 2017. Results: The cumulative incidences of grade 2-4 acute GVHD (G24GVHD), CMVR by day 100, and CMV disease by day 365 were 37.3%, 52.1%, and 2.9%, respectively. Patients with G24GVHD were associated with the subsequent development of CMVR, and the presence of CMVR also increased the risk of G24GVHD. In a landmark analysis at day 65, the cumulative incidence of NRM at 1 year was 5.4%, 10.0%, 13.9%, and 19.7% in patients with G24GVHD-/CMVR-, G24GVHD-/CMVR+, G24GVHD+/CMVR-, and G24GVHD+/CMVR+, respectively. In a multivariate analysis, CMVR was respectively associated with an increased risk of NRM by day 365 in patients without G24GVHD (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.24-2.05; P < .001) and with G24GVHD (HR, 1.34; 95% CI, 1.06-1.70; P = .014), but the interaction between G24GVHD and CMVR was not significant (P = .326). Subgroup analyses suggested that the joint effect of acute GVHD and CMVR might vary according to the baseline characteristics. Conclusions: These data regarding the close relationship between acute GVHD and CMVR should provide important implications for the treatment strategy after HCT.
AB - Background: Despite a strong association between acute graft-versus-host disease (GVHD) and cytomegalovirus reactivation (CMVR), the joint effect of acute GVHD and CMVR on nonrelapse mortality (NRM) has not been well studied. Methods: We evaluated the impact of CMVR on NRM stratified according to the development of acute GVHD using a landmark method. This study included 6078 patients who received their first allogeneic hematopoietic cell transplantation (HCT) with a preemptive strategy for CMVR between 2008 and 2017. Results: The cumulative incidences of grade 2-4 acute GVHD (G24GVHD), CMVR by day 100, and CMV disease by day 365 were 37.3%, 52.1%, and 2.9%, respectively. Patients with G24GVHD were associated with the subsequent development of CMVR, and the presence of CMVR also increased the risk of G24GVHD. In a landmark analysis at day 65, the cumulative incidence of NRM at 1 year was 5.4%, 10.0%, 13.9%, and 19.7% in patients with G24GVHD-/CMVR-, G24GVHD-/CMVR+, G24GVHD+/CMVR-, and G24GVHD+/CMVR+, respectively. In a multivariate analysis, CMVR was respectively associated with an increased risk of NRM by day 365 in patients without G24GVHD (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.24-2.05; P < .001) and with G24GVHD (HR, 1.34; 95% CI, 1.06-1.70; P = .014), but the interaction between G24GVHD and CMVR was not significant (P = .326). Subgroup analyses suggested that the joint effect of acute GVHD and CMVR might vary according to the baseline characteristics. Conclusions: These data regarding the close relationship between acute GVHD and CMVR should provide important implications for the treatment strategy after HCT.
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U2 - 10.1093/cid/ciaa1871
DO - 10.1093/cid/ciaa1871
M3 - Article
C2 - 33341890
AN - SCOPUS:85106208367
SN - 1058-4838
VL - 73
SP - E620-E628
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 3
ER -