Pretransplant CMV IgG titers and DNAemia are associated with CMV infections post-allogeneic hematopoietic cell transplant with or without letermovir

Figures

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  Figure 1.. Proportion of patients experiencing clinically significant CMV infection by day 180 posttransplant based on pretransplant CMV-IgG-titers (A). Clinically significant CMV infection was recorded as defined during the time period. Receiver Operating Characteristic (ROC) curve analysis to evaluate the IgG levels in distinguishing patients with higher risk for csCMVi (B): the area under the curve (AUC) was 0.73 (95% CI: .69–.78) and the optimal cutoff determined by Youden's index was at 44 IU/mL, with a sensitivity and specificity of 88% and 59%, respectively.

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  Figure 2.. CMV burden by day 180 stratified by pretransplant CMV-IgG-titers in the whole cohort (A–C), preletermovir (D–F) and postletermovir period (H–I). Pretransplant CMV-IgG-titers have been classified as high (positive and IgG ≥40 IU/mL, n = 267), low (positive and IgG <40 IU/mL n = 47), or negative (n = 171). A, D, G, Cumulative incidence of the first clinically significant CMV (csCMV) infection (≥150 IU/mL until 31 December 2022 or ≥500 IU/mL thereafter) in the high, low and negative IgG groups, respectively (detailed in Supplementary Table 1). B, E, H, Cumulative incidence of the first detected DNAemia (≥56 IU/mL until 16 May 2018 and ≥21 IU/mL thereafter) in the high, low and negative IgG groups, respectively. C, F, I. Comparison of the number of CMV-DNAemia episodes detected by d180. Abbreviation: Ns, nonsignificant, ****P < .0001.

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  Figure 3.. CMV burden by day 180 stratified by pretransplant CMV-DNAemia in the whole cohort (A–C), pre- (D–F) and postletermovir study period (H–I). Pretransplant DNAemia refers to the detection of at least 1 positive (detectable or quantifiable) CMV PCR from d-60 before the transplant until d0 (n = 61), and no DNAemia as undetectable CMV PCR (n = 360). A, D, G, Cumulative incidence of the first clinically significant CMV (csCMV) infection (≥150 IU/mL until 31 December 2022 or ≥500 IU/mL thereafter) in the DNAemia detectable and nondetectable groups, respectively (detailed in Supplementary Table 1). B, E, H, Cumulative incidence of the first detected DNAemia (≥56 IU/mL until 16 May 2018 and ≥21 IU/mL thereafter) in the DNAemia detectable and nondetectable groups, respectively. C, F, I, Comparison of the number of CMV-DNAemia episodes detected by d180. Abbreviation: Ns, nonsignificant, ***P < .001, ****P < .0001.

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  Figure 4.. CMV burden by day 180 stratified by the combination of pretransplant CMV-IgG-titers and CMV-DNAemia in the whole cohort (A–C), pre- (D–F) and postletermovir study period (H–I). Four groups are compared, patients with: both high pretransplant CMV-IgG-titers and pretransplant CMV-DNAemia (n = 55), either high pretransplant CMV-IgG-titers or pretransplant CMV-DNAemia (n = 218), both low pretransplant CMV-IgG-titers and undetectable (or not performed) pretransplant CMV PCR (n = 42), negative CMV-IgG and undetectable DNAemia pretransplant (n = 170). A, D, G, Cumulative incidence of the first clinically significant CMV (csCMV) infection (≥150 IU/mL until 31 December 2022 or ≥500 IU/mL thereafter) in the high IgG/DNAemia, high IgG or DNAemia, low IgG/undetectable DNAemia and negative IgG/undetectable DNAemia, respectively (detailed in Supplementary Table 1). B, E, H, Cumulative incidence of the first detected DNAemia (≥56 IU/mL until 16 May 2018 and ≥21 IU/mL thereafter) in the high IgG/DNAemia, high IgG or DNAemia, low IgG/undetectable DNAemia and negative IgG/undetectable DNAemia, respectively. C, F, I, Comparison of the number of CMV-DNAemia episodes detected by d180. Abbreviation:…

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  Figure 5.. Risk factors for csCMVi by day 180 posttransplant using Cox regression analysis (A). Predictors of mortality at 1-y posttransplant using Cox regression analysis (B). Abbreviations: HR, hazard ratio; CI, confidence interval.

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  Figure 6.. Nonvirological posttransplant clinical outcomes stratified by pretransplant CMV-IgG-titers (A–C) or pretransplant CMV-DNAemia (D–F) in the whole cohort. Pretransplant CMV-IgG-titers have been classified as high (n = 267), low (n = 47) or negative (n = 171).