Impact of baseline and week 2 and week 4 post-transplant CMV cell-mediated immunity on risk of CMV infections and mortality in allogeneic hematopoietic cell transplant recipients

Abstract Objective Cytomegalovirus (CMV) infection is a common opportunistic after allogeneic hematopoietic cell transplant (alloHCT). We explored whether change in CMV cell-mediated immunity (CMV CMI) during the first month predicts risk of development and all-cause mortality. Methods This was follow-up analysis using data from REACT study, multicenter prospective observational study CMV-seropositive alloHCT recipients. Production interferon gamma following ex-vivo stimulation with antigens IE1 pp65 assessed by ELISPOT assay at baseline, 2 4 weeks transplant. Clinically significant (CS-CMVi) defined as viremia and/or disease necessitating antiviral therapy. evaluated impact CMI changes baseline to on CS-CMVi Results The included 226 recipients occurred 64 patients (28%). On Cox-regression analyses, independent predictors negative delta Week spot counts (SPCs) [HR 3.65 (1.65-8.04); p= 0.001), SPCs 2.79 (1.46-5.35); p=0.002), ATG conditioning regimen, type transplant, female gender corticosteroid use. A Kaplan-Meir showed association an increased mortality (log rank test=0.041). Conclusion decrease CMV-specific T-cell responses may predict associated