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.
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.
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).
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.
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All authors have declared no conflicts of interest.