2299. Cytomegalovirus Infection in T Cell Replete Peripheral Blood Stem Cell Transplant with Post-Transplant Cyclophosphamide- A Single Center Experience
Session: Poster Abstract Session: Transplants: CMV and Transplantation
Saturday, October 29, 2016
Room: Poster Hall
Background:

T Cell Replete (TCR) Peripheral blood (PB) Hematopoietic Cell Transplant (HCT) with Post-transplant cyclophosphamide (PT/Cy) is an emerging transplant modality. We describe CMV infection in 52 consecutive TCR HCTs.

Methods:

This is a retrospective analysis of 52 consecutive TCR- PB, HCTs with PT/Cy as Graft vs. host disease (GvHD) prophylaxis performed at our institution from March 2014 to Feburary 2016.

Results:

Patient’s demographics are described in Table 1. Of the 41 patients at risk 29 (71%) experienced CMV reactivation, with end organ diseases in 17% patients (gastrointestinal ; n=3 ang lung; n=2). CMV reactivation was observed at a median of day +27 post-transplant (range 7-257). Median absolute lymphocyte count was 200 at the time of CMV reactivation (range 0-3700). Oral valganciclovir was the most common initial therapy (n=17, 59%), followed by IV foscarnet (n=6, 21%), IV ganciclovir (n=4, 14%) and study drug (n=2,7%). Median follow-up time was 251 days (range 9-785).

We analyzed age, gender and transplant type as risk factors for CMV reactivation. Age was not a risk factor for CMV reactivation (p=>0.99) whereas Female gender was (p=<0.001). Haploidentical HCTs had a higher rate of CMV reactivation compared to matched related donor HCTs (79% vs. 54%),not statistically significance (p=0.146). There was no association between CMV reactivation and BK hemorrhagic cystitis (p=0.734). Based on the CMV status for donor (D) and recipient (R), D+/R- combination was protective against CMV reactivation (p= 0.007). Amongst acute myeloid leukemia patients CMV was numerically associated with decreased disease relapse. CMV did not affect the overall survival (3 vs.5 deaths without vs with CMV reactivation arm, p= 0.715).

Conclusion:

We report high incidence and earlier CMV reactivation after TCR peripheral blood HCTs with PT/Cy highlighting the need of better predictive models with changing transplant modalities.

P.S: The most current GvHD data will be added to the results.

Table 1. Patient Demographics

Demographics

Number (n)

Percent (%)

Gender

Males

Females

34

18

65

35

Underlying malignancy

AML

ALL/Lymphoma

CML

PCL

Others

 

19

17

6

2

8

37

33

12

4

15

Transplant Type

Haploidentical

Matched Related donor

 

36

16

69

31

Conditioning regimen

Bu/Cy

Bu/Flu

Flu/Cy/CAMPATH/TBI

Flu/Cy/TBI

8

2

1

41

15.4

3.8

1.9

78.8

AT risk for CMV

D+/R+

D+/R-

D-/R+

D-/R-

 

16

15

10

11

31

29

19

21

Zainab Shahid, MD1, Jim Symanowski, Ph.D1, Sarah Lestrange, BS1, Saad Usmani, MD1, Michael Grunwald, MD1, Jonathan Gerber, MD1, Nilanjan Ghosh, MD1, Lewis Mccurdy, MD2, Omotayo Fasan, MD1, Jing Ai, MD1, Belinda Avalos, MD1 and Edward Copelan, MD1, (1)Carolinas HealthCare System, Levine Cancer Institute, Charlotte, NC, (2)Carolinas Healthcare System, Charlotte, NC

Disclosures:

Z. Shahid, None

J. Symanowski, None

S. Lestrange, None

S. Usmani, None

M. Grunwald, None

J. Gerber, None

N. Ghosh, None

L. Mccurdy, None

O. Fasan, None

J. Ai, None

B. Avalos, None

E. Copelan, None

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