Cytomegalovirus reactivation is associated with an increased risk of late-onset invasive aspergillosis independently of grade II–IV acute graft-versus-host disease in ... View Full Text


Ontology type: schema:ScholarlyArticle     


Article Info

DATE

2021-09-07

AUTHORS

Shun-ichi Kimura, Masaharu Tamaki, Keiji Okinaka, Sachiko Seo, Naoyuki Uchida, Aiko Igarashi, Yukiyasu Ozawa, Kazuhiro Ikegame, Tetsuya Eto, Masatsugu Tanaka, Souichi Shiratori, Hirohisa Nakamae, Masashi Sawa, Toshiro Kawakita, Makoto Onizuka, Takahiro Fukuda, Yoshiko Atsuta, Yoshinobu Kanda, Hideki Nakasone

ABSTRACT

There is a matter of debate about the clinical impact of cytomegalovirus (CMV) reactivation on the development of late-onset invasive aspergillosis (IA), which occurs 40 days or later after allogeneic hematopoietic stem cell transplantation (HSCT). Using a Japanese transplant registry database, we analyzed the risk factors for the development of late-onset IA in 21,015 patients who underwent their first allogeneic HSCT between 2006 and 2017. CMV reactivation was defined as the initiation of preemptive anti-CMV antiviral therapy. Overall, there were 582 cases of late-onset IA, which occurred at a median of 95 days after HSCT. The 2-year cumulative incidence was 3.4% (95% confidence interval (CI), 3.0–3.9) in patients with CMV reactivation within 40 days after HSCT and 2.5% (95% CI, 2.3–2.8) in those without it (P < 0.001). In a multivariate analysis, CMV reactivation as a time-dependent covariate was significantly associated with the development of late-onset IA (hazard ratio (HR) 1.40, P < 0.001), as well as grade II–IV acute GVHD, age > 50 and HCT-CI ≥ 3 in the entire cohort. If we focus on the subgroup without grade II–IV acute GVHD, which is generally an indication for systemic corticosteroid therapy (n = 12,622), CMV reactivation was still a significant factor for the development of late-onset IA (HR 1.37, P = 0.045) as well as age > 50 years, HCT-CI ≥ 3, and cord blood transplantation. In conclusion, CMV reactivation was associated with an increased risk of late-onset IA after allogeneic HSCT independently of acute GVHD. Close monitoring for late-onset IA is necessary for patients who develop CMV reactivation even without grade II–IV acute GVHD. More... »

PAGES

3029-3038

Journal

TITLE

Annals of Hematology

ISSUE

12

VOLUME

100

Identifiers

URI

http://scigraph.springernature.com/pub.10.1007/s00277-021-04660-3

DOI

http://dx.doi.org/10.1007/s00277-021-04660-3

DIMENSIONS

https://app.dimensions.ai/details/publication/pub.1140912074

PUBMED

https://www.ncbi.nlm.nih.gov/pubmed/34490500


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