CMV Reactivations and Their Impact On Outcomes in Patients After Hematopoietic Cell Transplantation
Bibliographic record
Abstract
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".