Transplant infectious disease : an official journal of the Transplantation Society · 2026
A Novel Indicator of Cytomegalovirus Infection After Allogeneic Hematopoietic Cell Transplantation: Current CMV Reactivation.
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Kawamura Shunto, Nakasone Hideki, Honjo Yuki, Takeshita Junko, Misaki Yukiko, Takano Kosuke, Yoshimura Kazuki, Hashino Koki, Yamamoto Kaisuke, Nakata Yuya, Ishikawa Takuto, Matsuoka Akari, Meno Tomohiro, Nakamura Yuhei, Kawamura Masakatsu, Yoshino Nozomu, Gomyo Ayumi, Tamaki Masaharu, Kusuda Machiko, Kimura Shun-Ichi, Kako Shinichi, Kanda Yoshinobu
Аннотация
BACKGROUND: Cytomegalovirus reactivation (CMVR) after allogeneic hematopoietic cell transplantation (allo-HCT) is a reversible event, and conventional indicators such as the simple cumulative incidence cannot reflect transitional CMVR states. We propose a novel indicator, current CMVR (cCMVR), which visualizes both the occurrence and remission of CMVR over time.
METHODS: To evaluate the utility of cCMVR, we analyzed 389 CMV seropositive patients who had received their first allo-HCT. cCMVR was defined as the probability of the state where anti-CMV drugs were administered for CMVR or CMV disease without relapse or death at any time.
RESULTS: We compared two groups with or without letermovir prophylaxis (LTV and no-LTV groups). The 1-, 2-, 3-, and 6-month cCMVR values were 0.0%, 0.0%, 2.9%, and 2.9% in the LTV group, and 7.1%, 31.9%, 11.0%, and 0.8% in the no-LTV group. In the LTV group, cCMVR never exceeded 10%, while in the no-LTV group, cCMVR peaked at approximately 2 months after allo-HCT, and fewer than 5% of patients developed CMVR after 4 months post-HCT. Next, in the no-LTV group, we assessed cCMVR stratified according to the presence of risk factors for the simple cumulative incidence of CMVR, and this revealed that patients grafted from HLA-mismatched related donors and those who received alemtuzumab for GVHD prophylaxis appeared to experience repeated episodes of CMVR, whereas the early difference in cCMVR according to pretransplant CMV-IgG titer diminished over time.
CONCLUSION: cCMVR could be a valuable indicator for visualizing recurrent CMV infection and illustrating differences in the time course of CMVR.
METHODS: To evaluate the utility of cCMVR, we analyzed 389 CMV seropositive patients who had received their first allo-HCT. cCMVR was defined as the probability of the state where anti-CMV drugs were administered for CMVR or CMV disease without relapse or death at any time.
RESULTS: We compared two groups with or without letermovir prophylaxis (LTV and no-LTV groups). The 1-, 2-, 3-, and 6-month cCMVR values were 0.0%, 0.0%, 2.9%, and 2.9% in the LTV group, and 7.1%, 31.9%, 11.0%, and 0.8% in the no-LTV group. In the LTV group, cCMVR never exceeded 10%, while in the no-LTV group, cCMVR peaked at approximately 2 months after allo-HCT, and fewer than 5% of patients developed CMVR after 4 months post-HCT. Next, in the no-LTV group, we assessed cCMVR stratified according to the presence of risk factors for the simple cumulative incidence of CMVR, and this revealed that patients grafted from HLA-mismatched related donors and those who received alemtuzumab for GVHD prophylaxis appeared to experience repeated episodes of CMVR, whereas the early difference in cCMVR according to pretransplant CMV-IgG titer diminished over time.
CONCLUSION: cCMVR could be a valuable indicator for visualizing recurrent CMV infection and illustrating differences in the time course of CMVR.