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Characterization of Viral Infections after Antithymocyte Globulin-Based Conditioning in Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation.
Biol Blood Marrow Transplant. 2019 09; 25(9):1837-1843.BB

Abstract

Antithymocyte globulin (ATG) has been shown to reduce the incidence of graft-versus-host-disease (GVHD) after matched related donor (MRD) and matched unrelated donor (MUD) hematopoietic stem cell transplantation (HCT); however, because of increased risks of infection and relapse, this use has not translated into a significant improvement in post-transplant survival. The goal of this single-center, retrospective cohort analysis was to quantify the incidence of viral reactivation and viral end-organ disease (EOD) within the first 100 days after MUD HCT with ATG-based conditioning compared with MRD HCT without ATG. Fifty-nine adult patients underwent ATG-based MUD HCT compared with 64 patients receiving MRD HCT without ATG. Cytomegalovirus reactivation was the most frequent event in both groups (65% MUD versus 61% MRD), followed by BK virus reactivation (26% versus 24%) and Epstein-Barr virus reactivation (20% versus 9%). A higher percentage of MUD patients experienced viral EOD by day +100 when compared with MRD patients (34% versus 16%, P = .022). This was most notable for EOD involving BK virus (15% versus 6%, P = .14) and Epstein-Barr virus (7% versus 0%, P = .050). Correspondingly, more patients in the MUD group experienced virus-related complications, including hospitalization (24% versus 3%, P < .001), intensive care unit admission (10% versus 6%, P = .19), and mortality (8% versus 4%, P = .44). There were no significant differences in either relapse-free survival (RFS; 62% versus 78%, P = .07) or overall survival (OS; 72% versus 86%, P = .07) at 6 months post-HCT. However, when using the final time point of 21 months in the MUD/ATG group and 23 months in the MRD/no ATG group, MUD patients who received ATG had inferior survival (OS: 27% versus 77%, P = .009; RFS: 40% versus 59%, P = .042). Our results add to and further quantify the infectious risks associated with the use of ATG in MUD transplants and promote the implementation of more intensive preemptive viral monitoring practices in patients receiving ATG-based MUD transplants.

Authors+Show Affiliations

Department of Pharmacy, Memorial Sloan Kettering Cancer Center, New York, New York.Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas.Department of Infectious Diseases, The University of Texas MD Anderson Cancer Center, Houston, Texas.Department of Stem Cell Transplantation and Cellular Therapy, The University of Texas MD Anderson Cancer Center, Houston, Texas.Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas.Division of Pharmacy, The University of Texas MD Anderson Cancer Center, Houston, Texas. Electronic address: JCYeh@mdanderson.org.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31128324

Citation

Figgins, Bradley, et al. "Characterization of Viral Infections After Antithymocyte Globulin-Based Conditioning in Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation." Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, vol. 25, no. 9, 2019, pp. 1837-1843.
Figgins B, Hammerstrom A, Ariza-Heredia E, et al. Characterization of Viral Infections after Antithymocyte Globulin-Based Conditioning in Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant. 2019;25(9):1837-1843.
Figgins, B., Hammerstrom, A., Ariza-Heredia, E., Oran, B., Milton, D. R., & Yeh, J. (2019). Characterization of Viral Infections after Antithymocyte Globulin-Based Conditioning in Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. Biology of Blood and Marrow Transplantation : Journal of the American Society for Blood and Marrow Transplantation, 25(9), 1837-1843. https://doi.org/10.1016/j.bbmt.2019.05.020
Figgins B, et al. Characterization of Viral Infections After Antithymocyte Globulin-Based Conditioning in Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. Biol Blood Marrow Transplant. 2019;25(9):1837-1843. PubMed PMID: 31128324.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Characterization of Viral Infections after Antithymocyte Globulin-Based Conditioning in Adults Undergoing Allogeneic Hematopoietic Stem Cell Transplantation. AU - Figgins,Bradley, AU - Hammerstrom,Aimee, AU - Ariza-Heredia,Ella, AU - Oran,Betul, AU - Milton,Denái R, AU - Yeh,Jason, Y1 - 2019/05/22/ PY - 2019/03/26/received PY - 2019/05/01/revised PY - 2019/05/17/accepted PY - 2019/5/28/pubmed PY - 2020/7/30/medline PY - 2019/5/26/entrez KW - Antithymocyte globulin KW - Hematopoietic stem cell transplantation KW - Transplantation conditioning KW - Viral infections SP - 1837 EP - 1843 JF - Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation JO - Biol Blood Marrow Transplant VL - 25 IS - 9 N2 - Antithymocyte globulin (ATG) has been shown to reduce the incidence of graft-versus-host-disease (GVHD) after matched related donor (MRD) and matched unrelated donor (MUD) hematopoietic stem cell transplantation (HCT); however, because of increased risks of infection and relapse, this use has not translated into a significant improvement in post-transplant survival. The goal of this single-center, retrospective cohort analysis was to quantify the incidence of viral reactivation and viral end-organ disease (EOD) within the first 100 days after MUD HCT with ATG-based conditioning compared with MRD HCT without ATG. Fifty-nine adult patients underwent ATG-based MUD HCT compared with 64 patients receiving MRD HCT without ATG. Cytomegalovirus reactivation was the most frequent event in both groups (65% MUD versus 61% MRD), followed by BK virus reactivation (26% versus 24%) and Epstein-Barr virus reactivation (20% versus 9%). A higher percentage of MUD patients experienced viral EOD by day +100 when compared with MRD patients (34% versus 16%, P = .022). This was most notable for EOD involving BK virus (15% versus 6%, P = .14) and Epstein-Barr virus (7% versus 0%, P = .050). Correspondingly, more patients in the MUD group experienced virus-related complications, including hospitalization (24% versus 3%, P < .001), intensive care unit admission (10% versus 6%, P = .19), and mortality (8% versus 4%, P = .44). There were no significant differences in either relapse-free survival (RFS; 62% versus 78%, P = .07) or overall survival (OS; 72% versus 86%, P = .07) at 6 months post-HCT. However, when using the final time point of 21 months in the MUD/ATG group and 23 months in the MRD/no ATG group, MUD patients who received ATG had inferior survival (OS: 27% versus 77%, P = .009; RFS: 40% versus 59%, P = .042). Our results add to and further quantify the infectious risks associated with the use of ATG in MUD transplants and promote the implementation of more intensive preemptive viral monitoring practices in patients receiving ATG-based MUD transplants. SN - 1523-6536 UR - https://www.unboundmedicine.com/medline/citation/31128324/Characterization_of_Viral_Infections_after_Antithymocyte_Globulin_Based_Conditioning_in_Adults_Undergoing_Allogeneic_Hematopoietic_Stem_Cell_Transplantation_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1083-8791(19)30331-3 DB - PRIME DP - Unbound Medicine ER -