Impact of anti-CMV IgG titers and CD34 count prior to hematopoietic stem cell transplantation from alternative donors.

Abstract Cytomegalovirus(CMV) reactivation remains one of the main infectious complications following hematopoietic stem cell transplantation(HSCT). The objectives of this paper are to study the role of anti-CMV antibodies titers in HSCT from alternative donors and to compare the CMV reactivation risks between posttransplant cyclophosphamide-based haploidentical HSCT and ATG-based URD HSCT. We included 98 CMV-positive patients, 30 undergoing haploidentical and 68, URD transplantation. Most patients had malignant diseases(84%), received myeloablative(78%) conditioning regimen and bone marrow graft(90%). The median pre-transplant anti-CMV IgG level was 109 U/mL. With median follow-up of 2.2 years, there were 72 CMV reactivations in 50 patients. There was no difference in CMV reactivation patterns between haploidentical and URD transplants. In multivariable analysis until the first event, the incidence of CMV reactivation was higher in patients with anti-CMV IgG levels greater than 100 U/mL(HR=2.38, p=0.005), in patients diagnosed with grades II-IV acute graft versus host disease(HR=10.8, p=0.003, after D+50) and lower in those who received higher doses of CD34 cells(HR=0.44, p=0.006). In multivariable analysis for recurring events, the incidence of CMV reactivation was higher in patients receiving reduced-intensity conditioning(HR=1.69, p=0.04) and in patients with acuted GVHD(HR=1.88, p=0.02), and lower in those who received higher doses of CD34 cells(HR=0.55, p=0.01). In summary, we have shown that pre-transplant anti-CMV IgG titers are correlated with CMV reactivation risk. More studies are needed to assess how this information can be incorporated in. High cellular grafts, which is a modifiable risk factor, also protects against CMV reactivation.