Pre-HCT CMV reactivation and risk of reactivation post-HCT
Zamora D, Xie H, Sadowska-Klasa A, et al. CMV Reactivation During Pre-Transplantation Evaluation: A Novel Risk Factor for Post-Transplantation CMV Reactivation. Blood Advances. 2024; (doi: 10.1182/bloodadvances.2023012234).
Researchers say high-risk allogeneic hematopoietic cell transplantation (HCT) recipients approaching their procedure date should be monitored for cytomegalovirus (CMV) reactivation, which predicts for post-HCT CMV reactivation and disease. The study included 1,694 patients, 11% of whom experienced pre-HCT reactivation of CMV 2 weeks prior to transplantation. The biggest risk factor for pre-HCT CMV reactivation was lymphopenia (≤300 cells/uL). Whether study participants underwent preemptive antiviral therapy (those whose procedures took place during 2007-17) or prophylaxis with letermovir (those whose transplants occurred during 2018-21), patients with pre-procedure CMV reactivation were significantly more likely to have a repeat occurrence by day 100 post-procedure. They also were more likely to die within 1 year of HCT. However, the probability of morbidity and mortality declined when CMV reactivation was effectively addressed before the HCT was performed. Based on their findings, the study authors recommend DNA PCR surveillance of high-risk HCT candidates and initiation of antiviral therapy as needed to quell CMV reactivation post-procedure.