Outcomes of refractory cytomegalovirus infection in the first year after allogeneic hematopoietic cell transplantation Journal Article

Authors: Karantoni, E.; Zavras, P. D.; Su, Y.; Fang, J.; Tamari, R.; Cho, C.; Perales, M. A.; Stern, A.; Papanicolaou, G. A.
Article Title: Outcomes of refractory cytomegalovirus infection in the first year after allogeneic hematopoietic cell transplantation
Abstract: Outcomes of refractory (Rf) cytomegalovirus (CMV) infection (CMVi) after hematopoietic cell transplantation (HCT) are poor owing to limited treatment options and treatment related toxicities. Maribavir, an orally bioavailable CMV antiviral, was recently approved for treatment of Rf-CMVi. Real-world studies quantifying the burden of Rf-CMVi prior to maribavir provide a benchmark for evaluating the net value of novel treatments. Here we report the incidence, clinical outcomes, and healthcare resource utilization (HRU) associated with Rf-CMVi in the first year post-HCT in a cohort of CMV-seropositive HCT recipients (R+) who underwent HCT between January 1, 2014, and December 31, 2017, at Memorial Sloan Kettering Cancer Center and were managed exclusively by preemptive therapy. CMVi was defined as CMV viremia treated preemptively. Rf-CMVi was defined as a <1 log10 decrease and CMV viral load >1000 U/mL after ≥14 days of appropriately dosed therapy. Welldays were defined as alive days not hospitalized and off CMV antivirals by 1 year post-HCT. The impact of Rf-CMVi on mortality and HRU was examined in multivariable models. Of the 286 R+ patients, 145 (50.7%) developed CMVi (99 no Rf-CMVi and 46 Rf-CMVi). Compared with the no Rf-CMVi group, the Rf-CMVi group had higher rates of CMV EOD (23.9% versus 10.1%; P = .030), CMV-related mortality (9.5% versus .0%; P = .002), and all-cause mortality (33.3% versus 15.6%; adjusted P = .049). Rf-CMVi was an independent predictor for readmission (adjusted odds ratio [aOR], 3.24; 95% confidence interval [CI], 2.19 to 4.87; P < .0001); CMV-related readmission (aOR, 9.48; 95% CI, 5.83 to 15.80; P < .0001), and decreased well days (adjusted arithmetic mean ratio, .72; 95% CI, .58 to .89; P = .001) in the first year post-HCT. Rf-CMVi is associated with increased mortality and increased HRU at 1 year after HCT. Improved therapies for Rf-CMVi have the potential of improving HCT outcomes and reducing HRU. © 2022 The American Society for Transplantation and Cellular Therapy
Keywords: mortality; hematopoietic stem cell transplantation; antivirus agent; cytomegalovirus infection; cytomegalovirus; graft recipient; antiviral agents; allogeneic hematopoietic cell transplantation; adverse event; viremia; transplant recipients; preemptive therapy; cytomegalovirus infections; humans; human; healthcare resource utilization; cmv end-organ disease; refractory cmv
Journal Title: Transplantation and Cellular Therapy
Volume: 28
Issue: 7
ISSN: 2666-6367
Publisher: Elsevier Inc.  
Date Published: 2022-07-01
Start Page: 403.e1
End Page: 403.e7
Language: English
DOI: 10.1016/j.jtct.2022.04.016
PUBMED: 35476955
PROVIDER: scopus
Notes: Article -- Export Date: 1 August 2022 -- Source: Scopus
Citation Impact
MSK Authors
  1. Miguel-Angel Perales
    657 Perales
  2. Christina Cho
    107 Cho
  3. Roni Tamari
    162 Tamari
  4. Yiqi Su
    15 Su
  5. Faidon Zavras
    10 Zavras
  6. Jiaqi Fang
    9 Fang
  7. Anat Stern
    10 Stern