Cytomegalovirus infection in allogeneic hematopoietic cell transplantation managed by the preemptive approach: Estimating the impact on healthcare resource utilization and outcomes Journal Article


Authors: Huang, Y. T.; Su, Y.; Kim, S. J.; Nichols, P.; Burack, D.; Maloy, M.; Giralt, S.; Perales, M. A.; Jakubowski, A. A.; Papanicolaou, G. A.
Article Title: Cytomegalovirus infection in allogeneic hematopoietic cell transplantation managed by the preemptive approach: Estimating the impact on healthcare resource utilization and outcomes
Abstract: We quantified cytomegalovirus (CMV) antiviral use and hospital length of stay (LOS) associated with CMV infection in a contemporary cohort of conventional (CONV) and CD34-selected (T cell–depleted) hematopoietic cell transplantation (HCT) recipients managed by preemptive therapy (PET) in a single US center. Adults who received first allogeneic HCT at Memorial Sloan Kettering Cancer Center from June 2010 through December 2014 were analyzed. Days on PET, number of readmissions, and readmission LOS by day 180 post-HCT were summarized. Estimated unit value (EUV) was defined as the expected number of PET days for a cohort of 100 HCT with characteristics as the analyzed cohort. Standardized incidence ratio was calculated as the ratio of observed outcomes of patients with CMV viremia over the outcomes of patients without CMV viremia. Of 318 patients, 88 received CONV and 230 CD34-selected HCT. Rates of CMV viremia were 26.3% for CONV and 41.9% for CD34-selected (P =.003). Among patients with viremia 68.2% CONV and 97.9% CD34-selected received PET. EUV for PET was 852 days and 2821 days for CONV and CD34-selected, respectively. The standardized incidence ratios for number of readmission and readmission LOS were 1.7 (95% confidence interval [CI], 1.4 to 2.1) and 1.2 (95% CI, 1.1 to 1.3), respectively, for CONV HCT and 1.7 (95% CI, 1.3 to 2.1) and 1.6 (95% CI, 1.5 to 1.7), respectively, for CD34-selected HCT. Overall survival was similar between patients with and without CMV viremia by HCT type. CMV end-organ disease was associated with lower overall survival only in CD34-selected HCT (P =.0007). CMV infection managed by PET requires substantial antiviral use and is associated with longer readmission LOS more, particularly among CD34-selected HCT. © 2018
Keywords: adult; major clinical study; overall survival; treatment duration; disease association; aciclovir; transplantation; health care utilization; length of stay; hospitalization; immunoglobulin g; graft versus host reaction; antivirus agent; hospital readmission; cd34 selection; foscarnet; ganciclovir; cytomegalovirus infection; allotransplantation; cell transplantation; valganciclovir; standardized incidence ratio; viremia; clinical outcome; preemptive therapy; health outcomes; human; male; female; article; cytomegalovirus (cmv) viremia; hematopoietic cell transplant (hct); t cell depletion (cd34-selected)
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 25
Issue: 4
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2019-04-01
Start Page: 791
End Page: 799
Language: English
DOI: 10.1016/j.bbmt.2018.11.012
PUBMED: 30476551
PROVIDER: scopus
PMCID: PMC6784540
DOI/URL:
Notes: Source: Scopus
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MSK Authors
  1. Sergio Andres Giralt
    754 Giralt
  2. Miguel-Angel Perales
    584 Perales
  3. Molly Anna Maloy
    246 Maloy
  4. Yao-Ting Huang
    28 Huang
  5. Seong Jin   Kim
    12 Kim
  6. Daniel A Burack
    6 Burack
  7. Yiqi Su
    10 Su