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The use of ATG abrogates the antileukemic effect of cytomegalovirus reactivation in patients with acute myeloid leukemia receiving grafts from unrelated donors.
Am J Hematol. 2015 Jun; 90(6):E117-21.AJ

Abstract

Several studies provided evidence of a consistent antileukemic effect induced by cytomegalovirus (CMV) replication in acute myeloid leukemia (AML) patients receiving allogeneic hematopoietic stem cell transplantation (HSCT), however the use of antithymocyte globulin (ATG) as graft-versus-host disease prophylaxis, may potentially abrogate the protective effect of CMV infection. To address this issue, we retrospectively analyzed the risk of relapse in a cohort of 101 patients with AML who received grafts from an unrelated donor after a conditioning regimen including ATG. The cumulative incidence of CMV reactivation, evaluated by RT qPCR, was 59% at 12 months, and 93% of CMV reactivations occurred within the first 100 days post HSCT. The 5-year cumulative incidence of relapse in patients with CMV reactivation was 29% compared with 37% for patients without CMV reactivation, and the only factor associated with a reduced 5-year cumulative incidence of relapse was the disease status at HSCT (P < 0.001). In the multivariable model adverse cytogenetics (HR 2.42, 95% CI 1.02-5.72; P = 0.044) and acute GVHD (HR 3.36, 95% CI 1.32-8.54; P = 0.011) were independent risk factors for reducing overall survival (OS), while the presence of chronic GVHD was associated with a better OS (HR 0.37, 95% CI 0.15-0.89; P = 0.027). CMV replication was not an independent risk factor for OS (HR 1.06, 95% CI 0.07-15.75; P = 0.965). In Conclusion, the results of present study suggest that relapse prevention in patients with AML receiving T-cell depleted HSCT using ATG do not benefit from CMV reactivation.

Authors+Show Affiliations

Department of Oncology and Hematology, Stem Cell Transplant Center, AOU Città Della Salute E Della Scienza, Turin, Italy.Division of Nuclear Medicine, AOU Città Della Salute E Della Scienza, Turin, Italy.Department of Hematology, AO Nazionale Alessandria, Alessandria, Italy.Department of Hematology, AO Nazionale Alessandria, Alessandria, Italy.Department of Oncology and Hematology, Stem Cell Transplant Center, AOU Città Della Salute E Della Scienza, Turin, Italy.Department of Oncology and Hematology, AOU Città Della Salute E Della Scienza, Turin, Italy.Department of Oncology and Hematology, Stem Cell Transplant Center, AOU Città Della Salute E Della Scienza, Turin, Italy.Department of Oncology and Hematology, AOU Città Della Salute E Della Scienza, Turin, Italy.Microbiology and Virology Unit, Laboratory of Virology, AOU Città Della Salute E Della Scienza, Turin, Italy.Microbiology and Virology Unit, Laboratory of Virology, AOU Città Della Salute E Della Scienza, Turin, Italy.Department of Oncology and Hematology, Stem Cell Transplant Center, AOU Città Della Salute E Della Scienza, Turin, Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25752810

Citation

Busca, Alessandro, et al. "The Use of ATG Abrogates the Antileukemic Effect of Cytomegalovirus Reactivation in Patients With Acute Myeloid Leukemia Receiving Grafts From Unrelated Donors." American Journal of Hematology, vol. 90, no. 6, 2015, pp. E117-21.
Busca A, Passera R, Pini M, et al. The use of ATG abrogates the antileukemic effect of cytomegalovirus reactivation in patients with acute myeloid leukemia receiving grafts from unrelated donors. Am J Hematol. 2015;90(6):E117-21.
Busca, A., Passera, R., Pini, M., Zallio, F., Dellacasa, C., Audisio, E., Giaccone, L., Maffini, E., Costa, C., Cavallo, R., & Bruno, B. (2015). The use of ATG abrogates the antileukemic effect of cytomegalovirus reactivation in patients with acute myeloid leukemia receiving grafts from unrelated donors. American Journal of Hematology, 90(6), E117-21. https://doi.org/10.1002/ajh.23998
Busca A, et al. The Use of ATG Abrogates the Antileukemic Effect of Cytomegalovirus Reactivation in Patients With Acute Myeloid Leukemia Receiving Grafts From Unrelated Donors. Am J Hematol. 2015;90(6):E117-21. PubMed PMID: 25752810.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The use of ATG abrogates the antileukemic effect of cytomegalovirus reactivation in patients with acute myeloid leukemia receiving grafts from unrelated donors. AU - Busca,Alessandro, AU - Passera,Roberto, AU - Pini,Massimo, AU - Zallio,Francesco, AU - Dellacasa,Chiara, AU - Audisio,Ernesta, AU - Giaccone,Luisa, AU - Maffini,Enrico, AU - Costa,Cristina, AU - Cavallo,Rossana, AU - Bruno,Benedetto, Y1 - 2015/04/01/ PY - 2015/01/30/received PY - 2015/02/23/revised PY - 2015/03/02/accepted PY - 2015/3/11/entrez PY - 2015/3/11/pubmed PY - 2015/7/30/medline SP - E117 EP - 21 JF - American journal of hematology JO - Am J Hematol VL - 90 IS - 6 N2 - Several studies provided evidence of a consistent antileukemic effect induced by cytomegalovirus (CMV) replication in acute myeloid leukemia (AML) patients receiving allogeneic hematopoietic stem cell transplantation (HSCT), however the use of antithymocyte globulin (ATG) as graft-versus-host disease prophylaxis, may potentially abrogate the protective effect of CMV infection. To address this issue, we retrospectively analyzed the risk of relapse in a cohort of 101 patients with AML who received grafts from an unrelated donor after a conditioning regimen including ATG. The cumulative incidence of CMV reactivation, evaluated by RT qPCR, was 59% at 12 months, and 93% of CMV reactivations occurred within the first 100 days post HSCT. The 5-year cumulative incidence of relapse in patients with CMV reactivation was 29% compared with 37% for patients without CMV reactivation, and the only factor associated with a reduced 5-year cumulative incidence of relapse was the disease status at HSCT (P < 0.001). In the multivariable model adverse cytogenetics (HR 2.42, 95% CI 1.02-5.72; P = 0.044) and acute GVHD (HR 3.36, 95% CI 1.32-8.54; P = 0.011) were independent risk factors for reducing overall survival (OS), while the presence of chronic GVHD was associated with a better OS (HR 0.37, 95% CI 0.15-0.89; P = 0.027). CMV replication was not an independent risk factor for OS (HR 1.06, 95% CI 0.07-15.75; P = 0.965). In Conclusion, the results of present study suggest that relapse prevention in patients with AML receiving T-cell depleted HSCT using ATG do not benefit from CMV reactivation. SN - 1096-8652 UR - https://www.unboundmedicine.com/medline/citation/25752810/The_use_of_ATG_abrogates_the_antileukemic_effect_of_cytomegalovirus_reactivation_in_patients_with_acute_myeloid_leukemia_receiving_grafts_from_unrelated_donors_ DB - PRIME DP - Unbound Medicine ER -