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Annals of Hematology

, Volume 94, Issue 2, pp 275–282 | Cite as

Early CMV replication and subsequent chronic GVHD have a significant anti-leukemic effect after allogeneic HSCT in acute myeloid leukemia

  • Ji Eun Jang
  • Soo Jeong Kim
  • June-Won Cheong
  • Shin Young Hyun
  • Yun Deok Kim
  • Yu Ri Kim
  • Jin Seok Kim
  • Yoo Hong MinEmail author
Original Article

Abstract

Early cytomegalovirus (CMV) replication (eCMV) after allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been suggested as an independent factor that reduces leukemia relapse risk. We retrospectively analyzed 74 patients with acute myeloid leukemia (AML) who underwent allo-HSCT between August 2006 and September 2012. All recipients were CMV seropositive. In 52 patients, eCMV occurred at a median of 35 days (range, 11–92) after allo-HSCT. Univariate analysis revealed that the factors associated with a reduction in the 5-year cumulative incidence of relapse (CIR) included the first complete remission status at allo-HSCT, non-adverse cytogenetics and molecular abnormalities, pre-transplant serum ferritin level <1,400 mg/dL, chronic graft-versus-host disease (cGVHD), and eCMV. In sub-group analysis, according to the existence of eCMV and cGVHD, those with both eCMV and cGVHD showed the lowest 5-year CIR (P < 0.003). Patients with both eCMV and cGVHD had the best outcome for leukemia-free survival (LFS) (P < 0.001) and OS (P < 0.001). In the CMV-seropositive population, the presence of eCMV in combination with cGVHD had a significant positive effect on LFS and OS after allo-HSCT. When eCMV preceded cGVHD, the relapse rate after allo-HSCT was significantly reduced in patients with AML. Therefore, we suggest that it is critical to have an immunological understanding of the graft-versus-leukemia effect in this setting.

Keywords

Cytomegalovirus Chronic GVHD Hematopoietic stem cell transplantation Relapse 

Notes

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

277_2014_2190_MOESM1_ESM.pdf (157 kb)
ESM 1 (PDF 156 kb)

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ji Eun Jang
    • 1
  • Soo Jeong Kim
    • 1
  • June-Won Cheong
    • 1
  • Shin Young Hyun
    • 2
  • Yun Deok Kim
    • 1
  • Yu Ri Kim
    • 1
  • Jin Seok Kim
    • 1
  • Yoo Hong Min
    • 1
    Email author
  1. 1.Division of Hematology, Department of Internal MedicineYonsei University College of MedicineSeoulSouth Korea
  2. 2.Division of Hematology–Oncology, Wonju College of MedicineYonsei UniversityWonjuSouth Korea

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