209MO - Impact of CMV reactivation on survival and relapse following allogeneic stem cell transplantation for de novo myeloid sarcoma

Background

Cytomegalovirus reactivation (CMV-R) following allogenic hematopoietic stem cell transplantation (allo-HCT) is a common complication with conflicting clinical impact. Prior studies have linked CMV-R to increased mortality after allo-HCT; however, prior studies linked CMV-R to decreased risk of relapse. We present survival outcomes related to CMV-R in 37 patients with de novo myeloid sarcoma (MS) treated with allo-HCT.

Methods

In this retrospective study, we analyzed medical records of adult patients with de novo MS who received allo-HCT at Mayo Clinic between 1996 and 2021. Survival outcomes were analyzed using Kaplan-Meier and Cox-proportional hazard models for univariate and multivariate analysis, respectively. CMV was identified via quantitative polymerase chain reaction in serum samples with reactivation defined as >500 CMV copies/mL.

Results

We identified 37 patients at Mayo Clinic who received allo-HCT for de novo MS. Isolated MS (iMS) without bone marrow involvement was observed in 38% patients, whereas 62% presented with synchronous MS (sMS) with bone marrow involvement. CMV-R occured in 39% previously CMV seropositive patients after allo-HCT, including 2 patients with iMS and 7 with sMS. Across all patients, median overall survival (mOS) was significantly lower at 13.7 months in patients with CMV-R versus 36.3 months without CMV-R (p=0.03). CMV-R was associated with increased mortality when adjusted for age and genomic risk stratification [HR 2.5; 95% CI: 1.05-6.17 (p=0.04)]. In sMS, CMV-R was associated with lower mOS at 13.7 months versus 36.3 months without CMV-R (p=0.03). Immunosuppression regimen did not impact incidence of CMV-R. The relapse rate after allo-HCT was 33% in patients with CMV-R versus 37% without CMV-R (p=1.0).

Conclusions

De novo MS is a rare form of AML with limited evidence to guide therapies. Given that many centers use CMV serostatus to guide donor selection, we sought to characterize the impact of CMV-R in allo-HCT in MS. In sMS, CMV-R was associated with decreased mOS by almost two years. CMV-R in iMS did not impact survival, although limited by small sample size. Effective CMV prophylaxis following allo-HCT can reduce mortality and improve survival outcomes in MS.

Clinical trial identification

Editorial acknowledgement

Legal entity responsible for the study

Mayo Clinic.

Funding

Has not received any funding.

Disclosure

All authors have declared no conflicts of interest.