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Cytomegalovirus infection is associated with AML relapse after allo-HSCT: a meta-analysis of observational studies

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Abstract

Cytomegalovirus (CMV) infection and primary disease relapse remain challenging problems after allogeneic hematopoietic stem cell transplantation (allo-HSCT). We sought to assess the association between CMV infection and disease relapse after transplantation. PubMed, EMBASE, the Cochrane Library, SCI, and Chinese Biomedicine Databases were searched up to July 1, 2018, for all studies that investigate pre-transplant CMV serostatus, CMV replication, and primary disease relapse in allo-HSCT patients with hematologic malignancies. Meta-analysis of 24 eligible cohort studies showed a significantly lower relapse risk after allo-HSCT in patients with CMV replication in acute myeloid leukemia (AML) (HR = 0.64, 95% CI, 0.50–0.83; P < 0.001) subgroup. However, CMV replication was associated with increased non-relapse mortality (NRM) in AML patients (HR = 1.64, 95% CI, 1.46–1.85; P < 0.001), but not associated with overall survival (OS) or graft-versus-host disease for AML patients (P > 0.05). There was no association between pre-transplant CMV serostatus and disease relapse, although D−/R− was associated with better OS in acute leukemia patients (HR = 0.89, 95% CI, 0.83–0.96; P = 0.003). In AML patients, CMV replication may be a protective predictor against disease relapse, although the potential benefit of CMV replication is offset by increased NRM.

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Funding

This work was supported by the National Natural Science Foundation of China (grant 81100388, grant 81470344).

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  1. Yu-Lin Zhang and Yan Zhu contributed equally to this work.

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  1. Department of Hematology, The First Affiliated Hospital of Chongqing Medical University, 1 Youyi Road, Yuzhong District, Chongqing, 400016, China

    Yu-Lin Zhang, Qing Xiao, Li Wang, Lin Liu & Xiao-Hua Luo

  2. Department of Hematology, Southwest Hospital, Third Military Medical University (Army Medical University), Chongqing, 400038, China

    Yan Zhu

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Zhang, YL., Zhu, Y., Xiao, Q. et al. Cytomegalovirus infection is associated with AML relapse after allo-HSCT: a meta-analysis of observational studies. Ann Hematol 98, 1009–1020 (2019). https://doi.org/10.1007/s00277-018-3585-1

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