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IMPACT OF CYTOMEGALOVIRUS REACTIVATION ON RELAPSE RATE AFTER ALLOGENEIC STEM CELL TRANSPLANTATION IN PATIENTS WITH ACUTE MYELOBLASTIC LEUKEMIA

PS1053

Ben Abdeljelil, N.1; Ben Hmida, M.1; Ouerghi, R.1; Lakhal, A.1; El Fatmi, R.1; Torjemane, L.1; Belloumi, D.1; Ladeb, S.1; Achour, W.1; Ben Othman, T.1

doi: 10.1097/01.HS9.0000562508.29273.89
Poster Session II: Acute myeloid leukemia - Clinical
Free

1Centre National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia

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Background:

Cytomegalovirus (CMV) infection is a major complication after allogeneic stem cell transplantation (ASCT).

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Aims:

The aim of the study was to evaluate the impact of CMV reactivation on the relapse rate after ASCT in patients with acute myeloid leukemia (AML).

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Methods:

Retrospective study conducted in patients with AML who underwent ASCT from HLA identical sibling donor between January 2011 and December 2018. Conditioning regimen consisted of Busulfex and Cyclophosphamide (Bu/Cy) or Fludarabine and Busulfex (F/Bu). Graft-versus-host disease (GVHD) prophylaxis consisted of cyclosporine and a short course of methotrexate. Antiviral prophylaxis for CMV infection was assured by Acyclovir from day +1 to day +180. CMV detection was carried out once-a-week from engraftment to day +100 by either pp 65 antigenemia test or real-time quantitative PCR.

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Results:

Ninety-three patients were enrolled (55 men and 38 women). Median age was 33 years (range, 5 - 49 y). At the time of transplant, 73 patients (78.5%) were in CR1, 16 patients (17.2%) were in CR2 and 4 patients (4.3%) were in response failure. CMV serostatus for donor (D) and recipient (R) was available for 44 cases (47.3%). Serostatus of R+/D+ and R+/D− was observed in 38 patients (86.4%). Stem cell source were BM in 49 cases (52.7%) and PBSC in 44 cases (47.3%). No graft failure was observed. Acute GVHD grade II-IV occurred in 19 patients (20.4%). Chronic GVHD was observed in 40 patients (45.4%). Twenty-nine patients (31.2%) developed CMV reactivation. With a median follow-up of 2 years (range 49 days - 7 years), the overall survival (OS) and the non-relapse mortality (NRM) were not statistically significant between patients with CMV reactivation and those without CMV reactivation (74% vs 63%, p = 0.3 and 20.7% vs 7.8%, p = 0.08, respectively). Twenty-four patients (25.8%) relapsed at a median of 6 months (range 2 - 67 months). the rate of relapse among patients with CMV reactivation was significantly lower than in those without CMV reactivation (10.3% vs 32.8%, p = 0.02). In univariate analysis, the CMV reactivation was the only factor associated with a decreased risk of relapse (OR = 0.23, 95% CI: 0.06-0.87, p = 0.02).

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Summary/Conclusion:

CMV reactivation was associated with decreased relapse risk after ASCT for patients with AML without a benefit in OS.

Copyright © 2019 The Authors. Published by Wolters Kluwer Health Inc., on behalf of the European Hematology Association.