CMV infection risk after PTCy in HLA-matched PBSC transplant

Oshima MU, Xie H, Zamora D, et al. Impact of GVHD Prophylaxis on CMV Reactivation and Disease After HLA-Matched Peripheral Blood Stem Cell Transplantation. Blood Advances. 2023; (doi: 10.1182/bloodadvances.2022009112).

A retrospective analysis concluded that cytomegalovirus (CMV) disease risk and 1-year viral burden following human leukocyte antigen (HLA)-matched peripheral blood stem cell (PBSC) transplantation is similar for post-transplantation cyclophosphamide (PTCy) and methotrexate (MTX)-based graft-versus-host-disease (GVHD) prophylaxis. The study compared CMV reactivation and disease among 780 seropositive patients who received HLA-matched PBSC grafts and PTCy (N=44), mycophenolate mofetil (MMF; N=414), or MTX (N=322). Multivariable adjustment revealed an association between PTCy and MMF and a higher risk of early (<day 100) CMV activation ≥250 IU/mL. At 1 year, the viral load area under the curve (AUC) was highest with MMF, while the AUC was similar between PTCy and MTX. The three cohorts had a similar CMV disease risk, and there was no relation between GVHD prophylaxis and CMV reactivation on chronic GVHD risk. CMV reactivation risk may be affected by various types of immunosuppressive agents, but corticosteroid exposure and infection risk may be reduced over time with effective GVHD prevention.

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Tags: GVHD, Transplant, Graft versus host disease, cell therapy, CMV, grafts, graft-versus-host disease, graft-vs-host disease, post transplant

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