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Impact of cytomegalovirus reactivation on relapse and survival in patients with acute leukemia who received allogeneic hematopoietic stem cell transplantation in first remission.
Oncotarget. 2016 Mar 29; 7(13):17230-41.O

Abstract

Cytomegalovirus (CMV)-reactivation is associated with graft-vs-leukemia (GVL) effect by stimulating natural-killer or T-cells, which showed leukemia relapse prevention after hematopoietic stem cell transplantation (HSCT). We enrolled patients with acute myeloid leukemia (n = 197) and acute lymphoid leukemia (n = 192) who underwent allogeneic-HSCT in first remission. We measured RQ-PCR weekly to detect CMV-reactivation and preemptively used ganciclovir (GCV) when the titer increased twice consecutively, but GCV was sometimes delayed in patients without significant graft-vs-host disease (GVHD) by reducing immunosuppressive agents. In the entire group, CMV-reactivation showed poor overall survival (OS). To evaluate subsequent effects of CMV-reactivation, we excluded early relapse and deaths within 100 days, during which most of the CMV-reactivation occurred. Untreated CMV-reactivated group (n = 173) showed superior OS (83.8% vs. 61.7% vs. 74.0%, p < 0.001) with lower relapse rate (10.1% vs 22.1% vs. 25.5%, p = 0.004) compared to GCV-treated CMV-reactivated group (n = 122) and CMV-undetected group (n = 42). After excluding chronic GVHD, untreated CMV-reactivated group still showed lower relapse rate (9.4% vs. 24.1% vs. 30.2%, p = 0.006). Multivariate analysis showed adverse-risk karyotype and patients in other than untreated CMV-reactivated group were independent factors for relapse prediction. Our data showed possible GVL effect of CMV-reactivation and minimizing antiviral therapy may benefit for relapse prevention in acute leukemia.

Authors+Show Affiliations

Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.Department of Hematology, Catholic Blood and Marrow Transplantation Center, Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Korea.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26883100

Citation

Yoon, Jae-Ho, et al. "Impact of Cytomegalovirus Reactivation On Relapse and Survival in Patients With Acute Leukemia Who Received Allogeneic Hematopoietic Stem Cell Transplantation in First Remission." Oncotarget, vol. 7, no. 13, 2016, pp. 17230-41.
Yoon JH, Lee S, Kim HJ, et al. Impact of cytomegalovirus reactivation on relapse and survival in patients with acute leukemia who received allogeneic hematopoietic stem cell transplantation in first remission. Oncotarget. 2016;7(13):17230-41.
Yoon, J. H., Lee, S., Kim, H. J., Jeon, Y. W., Lee, S. E., Cho, B. S., Lee, D. G., Eom, K. S., Kim, Y. J., Min, C. K., Cho, S. G., Min, W. S., & Lee, J. W. (2016). Impact of cytomegalovirus reactivation on relapse and survival in patients with acute leukemia who received allogeneic hematopoietic stem cell transplantation in first remission. Oncotarget, 7(13), 17230-41. https://doi.org/10.18632/oncotarget.7347
Yoon JH, et al. Impact of Cytomegalovirus Reactivation On Relapse and Survival in Patients With Acute Leukemia Who Received Allogeneic Hematopoietic Stem Cell Transplantation in First Remission. Oncotarget. 2016 Mar 29;7(13):17230-41. PubMed PMID: 26883100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of cytomegalovirus reactivation on relapse and survival in patients with acute leukemia who received allogeneic hematopoietic stem cell transplantation in first remission. AU - Yoon,Jae-Ho, AU - Lee,Seok, AU - Kim,Hee-Je, AU - Jeon,Young-Woo, AU - Lee,Sung-Eun, AU - Cho,Byung-Sik, AU - Lee,Dong-Gun, AU - Eom,Ki-Seong, AU - Kim,Yoo-Jin, AU - Min,Chang-Ki, AU - Cho,Seok-Goo, AU - Min,Woo-Sung, AU - Lee,Jong Wook, PY - 2015/12/12/received PY - 2016/01/29/accepted PY - 2016/2/18/entrez PY - 2016/2/18/pubmed PY - 2017/12/13/medline KW - acute lymphoid leukemia KW - acute myeloid leukemia KW - cytomegalovirus KW - graft-vs-leukemia SP - 17230 EP - 41 JF - Oncotarget JO - Oncotarget VL - 7 IS - 13 N2 - Cytomegalovirus (CMV)-reactivation is associated with graft-vs-leukemia (GVL) effect by stimulating natural-killer or T-cells, which showed leukemia relapse prevention after hematopoietic stem cell transplantation (HSCT). We enrolled patients with acute myeloid leukemia (n = 197) and acute lymphoid leukemia (n = 192) who underwent allogeneic-HSCT in first remission. We measured RQ-PCR weekly to detect CMV-reactivation and preemptively used ganciclovir (GCV) when the titer increased twice consecutively, but GCV was sometimes delayed in patients without significant graft-vs-host disease (GVHD) by reducing immunosuppressive agents. In the entire group, CMV-reactivation showed poor overall survival (OS). To evaluate subsequent effects of CMV-reactivation, we excluded early relapse and deaths within 100 days, during which most of the CMV-reactivation occurred. Untreated CMV-reactivated group (n = 173) showed superior OS (83.8% vs. 61.7% vs. 74.0%, p < 0.001) with lower relapse rate (10.1% vs 22.1% vs. 25.5%, p = 0.004) compared to GCV-treated CMV-reactivated group (n = 122) and CMV-undetected group (n = 42). After excluding chronic GVHD, untreated CMV-reactivated group still showed lower relapse rate (9.4% vs. 24.1% vs. 30.2%, p = 0.006). Multivariate analysis showed adverse-risk karyotype and patients in other than untreated CMV-reactivated group were independent factors for relapse prediction. Our data showed possible GVL effect of CMV-reactivation and minimizing antiviral therapy may benefit for relapse prevention in acute leukemia. SN - 1949-2553 UR - https://www.unboundmedicine.com/medline/citation/26883100/Impact_of_cytomegalovirus_reactivation_on_relapse_and_survival_in_patients_with_acute_leukemia_who_received_allogeneic_hematopoietic_stem_cell_transplantation_in_first_remission_ L2 - https://www.oncotarget.com/lookup/doi/10.18632/oncotarget.7347 DB - PRIME DP - Unbound Medicine ER -