Cytomegalovirus recurrence after autologous stem cell transplantation for multiple myeloma
Bibliographic record
Abstract
Background: Novel chemotherapeutic agents such as bortezomib and concomitant high-dose chemotherapy followed by autologous hematopoietic stem cell transplant (a-HSCT) for the treatment of multiple myeloma (MM) have increased the risk of recurrent cytomegalovirus (CMV) infection. Few studies have assessed the risk factors for CMV infection in this population. Methods: This retrospective single-centre study reviewed the incidence of, risk factors for, and treatment of CMV infection in patients with MM undergoing a-HSCT between June 2012 and May 2014. Results: Of 354 individuals who underwent a-HSCT during the study period, 242 were CMV seropositive, but 53 seropositive patients were excluded because of missing CMV viral load assessments. Of the 189 patients included in the analysis, 27 (14.3%) had a total of 28 significant CMV infections (defined by a PCR threshold >137 IU). CMV infections occurred within 3 weeks of a-HSCT. Of the patients with CMV infections, 33.3% (9/27) were symptomatic with fever. Therapy for CMV infection, however, was administered in 55.5% (15/27). Multivariate analysis identified 2 risk factors for CMV infection: baseline CMV viral load (OR 1.12, 95% CI 1.03 to 1.22; p=0.01) and receipt of a tandem a-HSCT within 6 months (HR 3.59, 95% CI 1.26 to 9.94; p=0.02). Conclusions: Further prospective studies with CMV viral load monitoring targeting patients at risk for CMV infection are needed to assess the risk, cost-effectiveness of monitoring, and benefit of pre-emptive therapy for prevention of CMV infection in such patients.
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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 | 0.004 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 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".