CMV Reactivation Is Associated With a Lower Incidence Of Relapse After Allo-SCT For ALL

CMV reactivation is an important cause of morbidity and mortality of allogeneic stem cell transplantation (allo-SCT). Recent studies demonstrated reduction of relapse risk after early replicative CMV infection in acute myelocytic leukemia (AML) and chronic myeloid leukemia (CML) patients. Here, we studied the relationship between CMV reactivation and leukemic relapse in acute lymphoblastic leukemia (ALL) patients.

115 patients (median age, 28 years; range, 14-56) with de novo ALL underwent allo-SCT from HLA-matched sibling (n=59) donors or unrelated (n=56) donors. CMV pp65 antigenemia was used for monitoring posttransplant CMV reactivation.

CMV reactivation before day 100 was observed in 47 patients (40.9%) (median day, 44 days, range, 10-100 days). The follow-up time varied from 10 to 90 months (median, 43 months), the estimated overall survival at 5 years was 52% in patients without opposed to 68% in patients with early pp65-antigenemia (P =.035). The 5-year disease free survival (DFS) was 39% vs 47% (P =.018). CMV pp65 antigenemia was associated with a decreased risk of relapse by day 100 among patients with ALL (HR 0.41, 95%CI 0.2-0.9) by multivariate analysis. Furthermore, CMV reactivation was associated with increased non-relapse mortality (HR 1.15, 95% CI 0.3-3.6).

Early replicative CMV infection is an independent and substantial factor associated with decreased leukemic relapse risk in ALL transplant recipients.

No relevant conflicts of interest to declare.