Challenges and factors associated with late CMV after allo-HCT
Sadowska-Klasa A, Özkök S, Xie H, et al. Late Cytomegalovirus Disease After Hematopoietic Cell Transplantation: Significance of Novel Transplantation Techniques. Blood Advances. 2024; (doi: 10.1182/bloodadvances.2023012175).
Scientists say better prevention strategies are needed to avoid delayed-onset cytomegalovirus (CMV) infection, which surfaces in some allogeneic hematopoietic cell transplantation (allo-HCT) patients months after the procedure. Providers have had notable success preventing CMV in the first 100 days post-transplant through preemptive therapy and letermovir prophylaxis. However, a retrospective analysis of 2,469 patients who were alive and CMV-seropositive at 100 days post-allo-HCT found that late-onset CMV disease occurs at a rate of 6.7% in this patient population. Post-transplant cyclophosphamide was linked to a higher risk of gastrointestinal CMV in multivariable Cox regression models. Factors associated with delayed-onset CMV include detection of CMV viremia before day 100, corticosteroid treatment after day 100 at a dosage of ≥1 mg/kg, development of acute and chronic graft-versus-host disease, lymphopenia, HLA-mismatched related donor status, and recipient age. As late CMV disease continues to occur despite new transplantation techniques and anti-CMV agents, the study authors suggest that day 100 survivors should be subjected to dynamic risk stratification with restart of PCR monitoring when immunosuppression increases.