Goldsmith SR, Abid MB, Auletta JJ, et al. Posttransplant Cyclophosphamide Is Associated With Increased Cytomegalovirus Infection: A CIBMTR Analysis. Blood. 2021; 137 (23) (doi: 10.1182/blood.2020009362).
An analysis of patients reported to the Center for International Blood and Marrow Transplantation Research between 2012 and 2017 found that post-transplant cyclophosphamide (PTCy) elevated the risk of cytomegalovirus (CMV) infection irrespective of donor. The researchers reviewed 757 haploidentical donor transplantation cyclophosphamide (HaploCy) recipients, 403 matched related (Sib) transplantation with PTCy recipients, and 1,605 who received Sib with calcineurin inhibitor-based prophylaxis (SibCNI). By day 180, the cumulative incidences of CMV in these groups were 42%, 37%, and 23%, respectively. CMV-seropositive recipients had the highest CMV infection risk; however, the risk was much higher among patients who received PTCy, regardless of donor. CMV infection risk also was higher among D+/R- patients. HaploCy led to worse overall survival and non-relapse mortality among R+ patients or those developing CMV infection, while neither CMV infection nor serostatus affected relapse. Overall, chronic graft-versus-host disease (cGVHD) occurred less frequently with PTCy, but CMV infection correlated with an increased incidence of chronic GVHD in PTCy recipients.