2290. Impact of Viral Load on Eradication of Cytomegalovirus (CMV) Viremia Amongst High-risk Allogeneic Stem Cell Transplant (SCT) Recipients
Session: Poster Abstract Session: Transplants: CMV and Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Background: The optimal threshold to initiate pre-emptive CMV therapy in SCT recipients remains to be defined.

Methods: Single center retrospective analysis of 110 consecutive allogeneic SCT recipients (Jan 2013 - Apr 2015). High risk for CMV was defined as seropositive recipients with ≥1 of these risk factors: anti thymocyte globulin (ATG), steroids (>0.5mg/kg), unrelated and mismatched donors, graft-vs-host disease (GVHD). Likelihood of achieving spontaneous clearance was determined by logistic regression models. CMV-related outcomes and non-relapse mortality (NRM) were assessed amongst patients who received antiviral therapy.

Results: 94 high risk patients were identified. 70 patients (75%) developed CMV viremia (Fig 1). Median time to reactivation was 15 (6-31) days post-SCT. Peak viremia ≥200 IU/mL was strongly associated with failure to achieve spontaneous clearance (RR, CI95%: 0.08, 0.03-0.22). Patients with peak viremia <200 IU/mL had a higher probability of spontaneous clearance independent of other risk factors (Table). Among treated patients, the median time to clearance of viremia was significantly shorter in those who started therapy at CMV <350 IU/mL (15 vs 32 days; P=0.001). Patients who started therapy at CMV ≥350 IU/mL were less likely to eradicate CMV by post-treatment day 28 (34 vs 71%; P=0.02). Unresolved CMV viremia by day 28 was associated with increased risk of therapeutic failure (35 vs 0%; P=0.001) and recurrent viremia (84 vs 39%; P=0.005). Therapeutic failure was associated with high NRM: 56, 78, 100% at 100, 200 and 365 days post-SCT (P<0.0001; Fig 2).

Conclusion:Among high risk SCT patients, peak CMV viremia ≥200 IU/mL is associated with >90% reduction in the probability of spontaneous clearance, and is a reasonable cutoff for pre-emptive therapy. CMV values ≥350 IU/mL are associated with adverse outcomes.

Jose F. Camargo, MD1, Luis Shimose, MD1,2, Maria X. Bueno, MD1,2, Rossana Rosa, MD1,2, Nikeshan Jeyakumar, MHS1, Michele I Morris, MD, FIDSA1, Lilian M. Abbo, MD1,2, Jacques Simkins, MD1, Maritza C. Alencar, DNP, ARNP-BC1,3, Cara Benjamin, PhD1,3, Mark Goodman, MD1,3, John J. Byrnes, MD1,3, Lazaros J. Lekakis, MD1,3, Denise Pereira, MD1,3 and Krishna V. Komanduri, MD1,3, (1)Department of Medicine, University of Miami Miller School of Medicine, Miami, FL, (2)Department of Medicine, Jackson Memorial Hospital, Miami, FL, (3)Adult Stem Cell Transplant Program, Sylvester Comprehensive Cancer Center, Miami, FL


J. F. Camargo, None

L. Shimose, None

M. X. Bueno, None

R. Rosa, None

N. Jeyakumar, None

M. I. Morris, Chimerix: Investigator and Scientific Advisor , Consulting fee and Research grant

L. M. Abbo, None

J. Simkins, None

M. C. Alencar, None

C. Benjamin, None

M. Goodman, None

J. J. Byrnes, None

L. J. Lekakis, None

D. Pereira, None

K. V. Komanduri, None

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