Poster Session II: Acute myeloid leukemia - Clinical
Cytomegalovirus (CMV) infection is a major complication after allogeneic stem cell transplantation (ASCT).
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).
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.
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).
CMV reactivation was associated with decreased relapse risk after ASCT for patients with AML without a benefit in OS.