Cytomegalovirus resistance in CD34+‐selected hematopoietic cell transplant recipients. Issue 3 (10th April 2018)

• Record Type: Journal Article
• Authors: Kim, Seong Jin; Huang, Yao‐Ting; Foldi, Julia; Lee, Yeon Joo; Maloy, Molly; Giralt, Sergio A.; Jakubowski, Ann A.; Papanicolaou, Genovefa A.
• Is Part Of: Transplant infectious disease. Volume 20:Issue 3(2018)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2018-04-10
• Subjects: CD34+‐selected -- Cytomegalovirus -- Genotype -- Hematopoietic stem cell transplantation -- Resistance; Transplantation of organs, tissues, etc -- Complications -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 617.01
• DOI: 10.1111/tid.12881
• Languages: English
• ISSNs: 1398-2273

Abstract

Abstract: Background: Cytomegalovirus (CMV) viremia after CD34 + ‐selected hematopoietic stem cell transplant (HCT) often requires prolonged antiviral therapy. We report rates and outcomes of resistant CMV in a contemporary cohort of CD34 + ‐selected HCT recipients managed preemptively. Methods: We retrospectively reviewed 220 consecutive, CMV‐seropositive recipients (R+), who received CD34 + ‐selected HCT at Memorial Sloan Kettering Cancer Center between June 2010 and December 2014. Patients were monitored by quantitative CMV PCR and were treated preemptively. CMV resistance was tested by a genotypic assay. Results: One hundred and sixty‐one (73%) patients developed CMV viremia and 47 (29% of viremic and 21% of total patients) had CMV resistance testing by one‐year from HCT. CMV resistance was confirmed in 19 (12% of viremic and 9% of total) patients and was identified >3 months from HCT in 90% of patients. Twelve patients had mutations in UL97 only; the remaining 7 patients had mutations in UL54 only or UL54 and UL97. By 1 year from HCT, 11 of 19 (58%) patients with mutations had CMV end‐organ disease. CMV‐related mortality in patients with resistance was 42%. Conclusions: Nine percent of CMV R+, CD34 + ‐selected HCT recipients had resistant CMV by 1 year from HCT. Of 19 patients with resistant CMV, 58% had CMV end‐organ disease and 42% died of CMV. Effective strategies for CMV prevention and restoration of CMV immunity are needed for CD34 + ‐selected HCT.