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Ann Hematol (2015) 94:275282 DOI 10.1007/s00277-014-2190-1
ORIGINAL ARTICLE
Early CMV replication and subsequent chronic GVHD have a significant anti-leukemic effect after allogeneic HSCT in acute myeloid leukemia
Ji Eun Jang & Soo Jeong Kim & June-Won Cheong &
Shin Young Hyun & Yun Deok Kim & Yu Ri Kim &
Jin Seok Kim & Yoo Hong Min
Received: 7 April 2014 /Accepted: 10 August 2014 /Published online: 20 August 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract Early cytomegalovirus (CMV) replication (eCMV) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been suggested as an independent factor that reduces leukemia relapse risk. We retrospectively analyzed 74 patients with acute myeloid leukemia (AML) who underwent allo-HSCT between August 2006 and September 2012. All recipients were CMV seropositive. In 52 patients, eCMV occurred at a median of 35 days (range, 1192) after allo-HSCT. Univariate analysis revealed that the factors associated with a reduction in the 5-year cumulative incidence of relapse (CIR) included the first complete remission status at allo-HSCT, non-adverse cytogenetics and molecular abnormalities, pre-transplant serum ferritin level <1,400 mg/dL, chronic graft-versus-host disease (cGVHD), and eCMV. In sub-group analysis, according to the existence of eCMV and cGVHD, those with both eCMV and cGVHD showed the lowest 5-year CIR (P<0.003). Patients with both eCMV and cGVHD had the best outcome for leukemia-free survival (LFS) (P < 0.001) and OS (P < 0.001). In the CMV-seropositive population, the presence of eCMV in combination with cGVHD had a significant positive effect on LFS and OS after allo-HSCT. When eCMV preceded cGVHD, the relapse rate after allo-HSCT was significantly reduced in
patients with AML. Therefore, we suggest that it is critical to have an immunological understanding of the graft-versus-leukemia effect in this setting.
Keywords Cytomegalovirus . Chronic GVHD . Hematopoietic stem cell transplantation . Relapse
Introduction
Despite the introduction of preemptive therapy for viral replication, cytomegalovirus (CMV) infection is regarded as an important cause of fatal complications after allogeneic hematopoietic stem cell transplantation (allo-HSCT) [13]. Although there were early observations on the beneficial effect of CMV infection in the mid-1980s, at that time, reliable detection methods and effective antiviral treatment were not yet available [4]. Recently, eCMV replication was revisited as an independent factor to reduce leukemic relapse risk in patients with...