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HSCT from CMV-positive donors decreased survival in CMV-negative patients
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Survival was decreased for cytomegalovirus-seronegative patients who received a hematopoietic allogeneic stem cell transplant, or HSCT, from an unrelated, seropositive donor, according to researchers with the European Group for Blood and Marrow Transplantation.
The researchers also found that cytomegalovirus (CMV)-seropositive donors improved survival among CMV-positive patients, if the patients received myeloablative conditioning.
“There was a strong interaction between the CMV serological status of the donor and conditioning intensity,” the researchers wrote in Clinical Infectious Diseases. “We found something new, namely that there was a protective effect of donor seropositivity resulting in improved overall survival in patients having received a myeloablative conditioning, while there was no such effect in patients receiving reduced intensity conditioning.”
Using data from the European Group for Blood and Marrow Transplantation (EMBT) database, the researchers evaluated the effect of donor CMV status on outcome after HSCT among 29,349 CMV-seropositive patients and 20,193 CMV-seronegative patients. The patients underwent transplant between 1992 and 2008.
Seronegative patients who received grafts from seropositive donors had a significantly lower overall survival compared with those who received grafts from seronegative donors (HR=1.13; 95% CI, 1.06-1.21). They also had a decreased relapse-free survival (HR=1.1; 95% CI, 1.03-1.19) and an increased nonrelapse mortality (HR=1.14; 95% CI, 1.04-1.24).
When adjusting for conditioning, seropositive patients who received grafts from seropositive donors had a nonsignificant effect on overall survival. But when the researchers estimated the effects of myeloablative conditioning and reduced intensity conditioning separately, they found those who received myeloablative conditioning had significantly improved overall survival (HR=0.91; 95% CI, 0.86-0.97) and a decreased nonrelapse mortality (HR=0.88; 95% CI, 0.81-0.95).
“In addition, CMV-seropositive patients receiving grafts from CMV-seronegative donors were more likely to die from viral infections,” the researchers wrote. “Although the EMBT registry does not make provision for distinction between different viral infections as the cause of death, the finding suggests that the presence of CMV-specific T cells is the key factor mediating the protective effect of donor serological status on overall survival.”
Disclosure: The researchers report no relevant financial disclosures.
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