Cytomegalovirus (CMV) management in allogeneic hematopoietic cell transplantation: Pre‐transplant predictors of survival, reactivation, and spontaneous clearance

Background Cytomegalovirus (CMV) reactivation is a frequent complication after allogeneic hematopoietic cell transplant (alloHCT). Method We analyzed 159 alloHCT recipients with 4409 quantitative CMV viral loads to determine pre-transplant predictors of reactivation, clinically significant infection (cs-CMVi, defined as load >1000 IU/mL), disease, kinetics spontaneous clearance CMV, and survival using standardized pre-emptive therapy approach identify at-risk groups target prevention strategies. Results Cs-CMVi was most common in D−/R+ unrelated donor transplants (URD). Spontaneous occurred 26% patients who reached 56-137 IU/mL, 6% at 138-250 IU/mL one patient >250 IU/mL. Median time between the first (>56 IU/mL) 13 days, whereas from reach vial 4 days. associated increase non-relapse mortality (NRM) on multivariate analysis. Conclusions Overall, this study indicates that URD are high-risk for cs-CMVi- CMV-related mortality, potential candidates targeted prophylaxis. beyond 250 uncommon, suggesting could be used an appropriate threshold initiate therapy.