CMV Reactivations and Their Impact On Outcomes in Patients After Hematopoietic Cell Transplantation
Notice bibliographique
Résumé
Abstract Abstract 4501 Introduction: CMV (Cytomegalovirus) reactivations are a major cause of morbidity and mortality in recipients of hematopoietic cell transplantation (HCT). Risk factors for CMV reactivations have not been fully elucidated. We evaluated first and subsequent CMV reactivations. Methods: Three hundred and forty seven patients transplanted consecutively between year 2005 and 2010 at Princess Margaret Hospital were assessed. CMV monitoring was performed by pp65 antigenemia testing. Positive patients (defined as >1 positive cells per 105 peripheral blood leukocytes examined) were treated preemptively with ganciclovir. 206(59%) patients received HCTs from related and 141(41%) from unrelated donors. 152(44%) were female and 195(56%) male. Graft versus host disease (GVHD) prophylaxis included Cyclosporine (CSA)/Mycophenolate mofetil (MMF) (n=100, 28.8%), CSA/Methotrexate (MTX) (n=101, 29.1%), CSA/CAMPATH (n=139, 40%), other (n=7, 2%). Results: With a median follow up of 15 months, 132 patients (38%) had at least one CMV reactivation. 67(51%) were Recipient (R) +/Donor (D) +, 61(46%) R+/D- and 4(3%) R-/D+. The median time to first reactivation was 35.5 days with a range from 13 – 1052 days. Risk factors for the occurrence of the first CMV reactivation were analyzed using death and relapse as competing risk factors. Older age at transplant (p-value 0.0375), female gender of recipients (p-value-0.0193) and presence of GVHD (p-value-0.0002) were significant factors for first CMV reactivations by univariate analysis. Conditioning regimens (p-value- 0.3294), donor type (p-value 0.1769) and lymphocyte count on the day of reactivation (p-value- 0.2308) were not significantly associated with first CMV reactivation. GVHD prophylaxis showed a trend (p-value- 0.0587). Multivariate analysis confirmed older age at transplant (p-value- 0.0258, odds ratio 1.024, 95%CI [1.003–1.045]), female gender of recipient (p-value- 0.0123, odds ratio 1.838, 95%CI [1.141–2.959]), GVHD prophylaxis with alemtuzumab (p-value 0.0324, odds ratio 2.121, 95%CI [1.148–3.917]) and presence of GVHD (p-value- <0.0001), odds ratio 2.935, 95%CI [1.754–4.910]) as independent variables. The time to first CMV reactivation was shorter in patients with GVHD prophylaxis using alemtuzumab containing regimens (34 days vs 60 days for CSA + MTX and 105 days for CSA + MMF, p= 0.0241), with low lymphocyte counts (<0.75 × 109/L, 42 days vs 112 days, p=0.0015), and presence of GVHD (40 days vs 79 days, p= 0.05). A number of patients experienced second or multiple CMV reactivations (Table 1) with a maximum of 10 reactivations. The median time to a subsequent reactivation from previous was 44 (range 35–127) days. The overall survival of patients that have not reactivated (Fig. 1) was not significantly different from that of patients with either 1 or multiple CMV reactivations (Fig. 2). Conclusion: Age at transplant, female gender of recipients, GVHD prophylaxis and presence of GVHD were identified as risk factors for the first CMV reactivation. The time to first reactivation was influenced by GVHD prophylaxis, lymphocyte count and presence of GVHD. Overall survival was not affected by CMV reactivations. Disclosures: No relevant conflicts of interest to declare.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,000 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».