Cytomegalovirus viremia is associated with an increased risk of death in the first year following hematopoietic cell transplantation (HCT) regardless of the use of pre-emptive therapy, a study published in the journal The Lancet Oncology has shown.1
Although cytomegalovirus viral load is frequently used to guide pre-emptive therapy in patients who have undergone HCT, there are limited data on the relationship between viremia and clinical outcomes. Therefore, researchers sought to assess the association between cytomegalovirus viral load and mortality in the year after HCT.
For the retrospective study, researchers analyzed data from 926 patients who received allogeneic HCT at the Fred Hutchinson Cancer Research Center in Seattle, Washington, between 2007 and 2013. All patients were cytomegalovirus seropositive or had a seropositive donor, and underwent weekly plasma cytomegalovirus monitoring until day 100 posttransplantation.
Results showed that the overall mortality rate was 30.0% (95% CI: 26.9-33.0) 1 year after HCT. Researchers found that 95 patients developed cytomegalovirus disease, which was the cause of death in 1% of the 263 patients who died in the first year after HCT.
The study also demonstrated that a cytomegalovirus viral load of 250 IU/mL or greater was associated with increased risk of death between day 0 and day 60 after HCT (HR, 19.8; 95% CI: 9.6-41.1). This risk of death was much lower after day 60 (HR, 1.8; 95% CI: 1.3-2.3).
Higher cytomegalovirus viral load thresholds had similar associations with overall mortality.
1. Green ML, Leisenring W, Xie H, et al. Cytomegalovirus viral load and mortality after haemopoietic stem cell transplantation in the era of pre-emptive therapy: a retrospective cohort study [published online ahead of print February 19, 2016]. Lancet Haematol. doi:10.1016/S2352-3026(15)00289-6.