Cytomegalovirus infection and treatment in allogeneic hematopoietic stem cell transplantation: a retrospective study from a single institution in an endemic area.

: Amac: Sitomegalovirus (CMV) enfeksiyonu, allojeneik kok hucre transplantasyonu (allo-KHT) sonrasi major bir komplikasyon olmasina ragmen CMV’nin endemik oldugu alanlarda CMV reaktivasyonu ve tedavi basarisizligi icin risk faktorleri belirsizligini korumaktadir. Bu calisma CMV’nin buyuk olcude endemik oldugu bir alanda allo-KHT alicilarinda CMV reaktivasyonu icin risk faktorlerini arastirmistir. Gerec ve Yontemler: CMV endemik oldugu bir alandan 82 allo-KHN alicisinin tibbi kayitlari retrospektif olarak incelendi. Hastalar iki gruba ayrildi: CMV reaktivasyonu olan (n=32) ve CMV reaktivasyonu olmayan (n=50). CMV reaktivasyonu ve tedavi basarisizligi ile iliskili olasi degiskenler arastirildi. Bulgular: Tek degiskenli analiz CMV reaktivasyonunun remisyon-olmayan hastalik durumu [risk orani (RO): 2,15; p=0,032) ve ≥grade III akut graft versus host hastaligi (GVHH) (RO: 3,07; p=0,002) ile iliskili oldugunu gosterdi. Cok degiskenli analiz ayrica CMV reaktivasyonunun ileri yas (RO: 1,03; p=0,029) ve ≥grade III akut GVHH (RO: 2,98; p=0,012) ile iliskili oldugunu gosterdi. Genel sagkalim CMV reaktivasyonu olan hastalarda CMV reaktivasyonu olmayan hastalardan daha dusuk gorunmekle birlikte fark istatistiksel olarak anlamli degildi (p=0,165). Bu calismada, ≥grade III akut GVHH yoklugu basarili CMV tedavisi ile iliskili idi (olasilik orani: 4,40; p=0,008). Sonuc: Profilaktik anti-CMV tedavisinin ≥grade III GVHH olan allo-KHT alicilarinda dikkate alinmasi gerekebilir. MATERIALS AND METHODS: Medical records of 82 allo-HSCT recipients from a CMV endemic area were retrospectively reviewed. The patients were stratified into two groups: those with CMV reactivation (n=32) and those without CMV reactivation (n=50). We investigated possible variables associated with CMV reactivation and treatment failure. RESULTS: Univariate analyses showed that non-remission disease status [hazard ratio (HR): 2.15; p=0.032] and ≥grade III acute graft-versus-host disease (GVHD) (HR: 3.07; p=0.002) were associated with CMV reactivation. Multivariate analysis further demonstrated that older age (HR: 1.03; p=0.029) and ≥grade III acute GVHD (HR: 2.98; p=0.012) were associated with CMV reactivation. Overall survival time seemed lower among patients with CMV reactivation than among patients without CMV reactivation, although the difference was not statistically significant (p=0.165). The absence of ≥grade III acute GVHD was associated with successful CMV treatment in the current study (odds ratio: 4.40; p=0.008). CONCLUSION: Prophylactic anti-CMV therapy might need to be considered for allo-HSCT recipients who have ≥grade III GVHD.