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A risk score for early cytomegalovirus reactivation after allogeneic stem cell transplantation identifies low-, intermediate-, and high-risk groups: reactivation risk is increased by graft-versus-host disease only in the intermediate-risk group.
Transpl Infect Dis. 2012 Apr; 14(2):141-8.TI

Abstract

BACKGROUND

This retrospective study was aimed at establishing a clinical score to stratify the risk of cytomegalovirus (CMV) reactivation in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) in order to direct strategies for post-transplant CMV monitoring and therapy.

PATIENTS AND METHODS

In total, 335 adult patients undergoing HSCT were analyzed and divided into a training set (n = 235) and a validation set (n = 100). Logistic regression analysis on the training set identified recipient and donor CMV seropositivity, acute graft-versus-host disease (GVHD), and use of anti-thymocyte globulin or alemtuzumab as significant risk factors for CMV reactivation. Weighted scores were assigned to each factor. A weighted score (CMV scoring index [CSI]) was calculated for each patient using the scores of all risk factors except for GVHD. The index was collapsed into 3 risk groups - low risk (score of 0-2), intermediate risk (score of 3-5), and high risk (score of 6-7) - and reactivation rates were calculated. In the training set, CMV reactivation occurred in 5.8% in the low-risk group, 44.8% in the intermediate-risk group, and 67.7% in the high-risk group.

RESULTS

In patients with an intermediate CSI only, significantly higher reactivation rates were seen in the presence of corticosteroid treatment for GVHD (57.8% vs. 24.5%, P < 0.01). These findings were similar in the validation set with reactivation rates of 0% in the low-risk, 46% in the intermediate-risk, and 68.4% in the high-risk groups. As seen in the training set, the presence of GVHD was associated with higher CMV reactivation rates only in the intermediate-risk group (64% vs. 28% in the absence of GVHD, P = 0.02).

CONCLUSIONS

Identification of these 3 risk groups in association with the presence or absence of GVHD will help transplant units to make pre-transplant policy decisions about prophylactic, pre-emptive, or experimental CMV prevention strategies in groups of patients undergoing HSCT, as well as in those developing GVHD post transplant.

Authors+Show Affiliations

Department of Haematology, University of Sydney, Westmead Hospital, Sydney, New South Wales, Australia.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

22283838

Citation

George, B, et al. "A Risk Score for Early Cytomegalovirus Reactivation After Allogeneic Stem Cell Transplantation Identifies Low-, Intermediate-, and High-risk Groups: Reactivation Risk Is Increased By Graft-versus-host Disease Only in the Intermediate-risk Group." Transplant Infectious Disease : an Official Journal of the Transplantation Society, vol. 14, no. 2, 2012, pp. 141-8.
George B, Kerridge IH, Gilroy N, et al. A risk score for early cytomegalovirus reactivation after allogeneic stem cell transplantation identifies low-, intermediate-, and high-risk groups: reactivation risk is increased by graft-versus-host disease only in the intermediate-risk group. Transpl Infect Dis. 2012;14(2):141-8.
George, B., Kerridge, I. H., Gilroy, N., Huang, G., Hertzberg, M. S., Bradstock, K. F., & Gottlieb, D. J. (2012). A risk score for early cytomegalovirus reactivation after allogeneic stem cell transplantation identifies low-, intermediate-, and high-risk groups: reactivation risk is increased by graft-versus-host disease only in the intermediate-risk group. Transplant Infectious Disease : an Official Journal of the Transplantation Society, 14(2), 141-8. https://doi.org/10.1111/j.1399-3062.2011.00706.x
George B, et al. A Risk Score for Early Cytomegalovirus Reactivation After Allogeneic Stem Cell Transplantation Identifies Low-, Intermediate-, and High-risk Groups: Reactivation Risk Is Increased By Graft-versus-host Disease Only in the Intermediate-risk Group. Transpl Infect Dis. 2012;14(2):141-8. PubMed PMID: 22283838.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A risk score for early cytomegalovirus reactivation after allogeneic stem cell transplantation identifies low-, intermediate-, and high-risk groups: reactivation risk is increased by graft-versus-host disease only in the intermediate-risk group. AU - George,B, AU - Kerridge,I H, AU - Gilroy,N, AU - Huang,G, AU - Hertzberg,M S, AU - Bradstock,K F, AU - Gottlieb,D J, Y1 - 2012/01/29/ PY - 2011/07/17/received PY - 2011/09/22/revised PY - 2011/10/19/accepted PY - 2012/1/31/entrez PY - 2012/1/31/pubmed PY - 2012/8/21/medline SP - 141 EP - 8 JF - Transplant infectious disease : an official journal of the Transplantation Society JO - Transpl Infect Dis VL - 14 IS - 2 N2 - BACKGROUND: This retrospective study was aimed at establishing a clinical score to stratify the risk of cytomegalovirus (CMV) reactivation in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT) in order to direct strategies for post-transplant CMV monitoring and therapy. PATIENTS AND METHODS: In total, 335 adult patients undergoing HSCT were analyzed and divided into a training set (n = 235) and a validation set (n = 100). Logistic regression analysis on the training set identified recipient and donor CMV seropositivity, acute graft-versus-host disease (GVHD), and use of anti-thymocyte globulin or alemtuzumab as significant risk factors for CMV reactivation. Weighted scores were assigned to each factor. A weighted score (CMV scoring index [CSI]) was calculated for each patient using the scores of all risk factors except for GVHD. The index was collapsed into 3 risk groups - low risk (score of 0-2), intermediate risk (score of 3-5), and high risk (score of 6-7) - and reactivation rates were calculated. In the training set, CMV reactivation occurred in 5.8% in the low-risk group, 44.8% in the intermediate-risk group, and 67.7% in the high-risk group. RESULTS: In patients with an intermediate CSI only, significantly higher reactivation rates were seen in the presence of corticosteroid treatment for GVHD (57.8% vs. 24.5%, P < 0.01). These findings were similar in the validation set with reactivation rates of 0% in the low-risk, 46% in the intermediate-risk, and 68.4% in the high-risk groups. As seen in the training set, the presence of GVHD was associated with higher CMV reactivation rates only in the intermediate-risk group (64% vs. 28% in the absence of GVHD, P = 0.02). CONCLUSIONS: Identification of these 3 risk groups in association with the presence or absence of GVHD will help transplant units to make pre-transplant policy decisions about prophylactic, pre-emptive, or experimental CMV prevention strategies in groups of patients undergoing HSCT, as well as in those developing GVHD post transplant. SN - 1399-3062 UR - https://www.unboundmedicine.com/medline/citation/22283838/A_risk_score_for_early_cytomegalovirus_reactivation_after_allogeneic_stem_cell_transplantation_identifies_low__intermediate__and_high_risk_groups:_reactivation_risk_is_increased_by_graft_versus_host_disease_only_in_the_intermediate_risk_group_ L2 - https://doi.org/10.1111/j.1399-3062.2011.00706.x DB - PRIME DP - Unbound Medicine ER -