Pretransplant high CMV-IgG-titers and detectable CMV-DNAemia were strongly associated with higher incidence of posttransplant clinically-significant CMV infections (aHR 14.18 and 2.43, respectively; p<0.001).
Cohort (n=485)
No
Are pretransplant high CMV-IgG-titers and detectable CMV-DNAemia associated with higher incidence of posttransplant clinically-significant CMV infections in adult allo-HCTR?
Pretransplant high CMV-IgG-titers and detectable DNAemia are strong predictors of posttransplant clinically-significant CMV infections in allo-HCT recipients, suggesting a role for baseline CMV burden in risk stratification.
Effect estimate: aHR 14.18
Absolute Event Rate: 47.6% vs 22.5%
p-value: p=<0.001
Abstract Background The impact of pretransplant CMV serology and DNAemia on posttransplant clinically-significant CMV infections (csCMVi) in allogeneic hematopoietic cell transplant recipients (allo-HCTR) is poorly described. Methods We performed a single-center cohort study of adult allo-HCTR (16.11.2015-31.12.2023). Letermovir prophylaxis was administered after 01.05.2019 during 100 days (d) posttransplant in CMV-seropositive patients (R+). We investigated associations of pretransplant CMV-IgG-titers and CMV-DNAemia with posttransplant csCMVi and CMV-DNAemia during 6 months posttransplant. In CMVR+, CMV-IgG-titers were classified as “low” (40 IU/mL) or “high” (≥40 IU/mL). Quantitative CMV-PCR was performed pre-HCT, weekly for 3 months and as clinically-indicated. Results Among 485 patients included, 209 and 276 underwent a first allo-HCT in the pre- and post-letermovir periods, respectively; 314/485 (64.7%) patients were CMVR+. Patients with high CMV-IgG-titers had a higher incidence of csCMVi by d180 posttransplant (47.6%, 95%CI 41.4-53.6) than those with low CMV-IgG-titers (22.5%, 95%CI 11.5-35.7) and CMVR- (3.6%, 95%CI 1.5-7.2, p0.001), and higher incidence of any CMV-DNAemia (p0.001). Overall, 61/485 (12.6%) HCT were performed in patients with detectable/quantifiable pretransplant CMV-DNAemia, with higher posttransplant incidence of csCMVi by d180 (61.3%, 95%CI 47.6-72.4) compared to those with undetectable pretransplant CMV-DNAemia (26.9%, 95%CI 22.3-31.6, p0.001) and higher incidence of any CMV-DNAemia (p0.001). Pretransplant high CMV-IgG-titers (aHR: 14.18, p0.001) and CMV-DNAemia (aHR: 2.43, p0.001) were strong predictors of posttransplant csCMVi. Conclusion Pretransplant high CMV-IgG-titers and detectable DNAemia were associated with higher posttransplant csCMVi/CMV-DNAemia incidence, including in the letermovir era. Additional studies on the clinical utility of baseline pretransplant CMV burden in CMV prophylaxis stratification algorithms are needed.
Royston et al. (2026) conducted a cohort in Allogeneic hematopoietic cell transplant recipients (n=485). Pretransplant high CMV-IgG-titers (≥40 IU/mL) and detectable CMV-DNAemia vs. Low CMV-IgG-titers (<40 IU/mL) and undetectable CMV-DNAemia was evaluated on Clinically-significant CMV infections (csCMVi) by day 180 posttransplant (aHR 14.18, p=<0.001). Pretransplant high CMV-IgG-titers and detectable CMV-DNAemia were strongly associated with higher incidence of posttransplant clinically-significant CMV infections (aHR 14.18 and 2.43, respectively; p<0.001).