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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 Min 
 ANNALS OF HEMATOLOGY, Vol.94(2) : 275-282, 2015 
Journal Title
Issue Date
Acute Disease ; Adolescent ; Adult ; Cytomegalovirus/immunology* ; Cytomegalovirus/physiology ; Cytomegalovirus Infections/blood ; Cytomegalovirus Infections/immunology* ; Cytomegalovirus Infections/virology ; Female ; Follow-Up Studies ; Graft vs Host Disease/etiology ; Graft vs Host Disease/immunology* ; Graft vs Host Disease/virology ; Hematopoietic Stem Cell Transplantation/adverse effects ; Hematopoietic Stem Cell Transplantation/methods* ; Host-Pathogen Interactions/immunology ; Humans ; Kaplan-Meier Estimate ; Leukemia, Myeloid/immunology* ; Leukemia, Myeloid/therapy ; Leukemia, Myeloid/virology ; Male ; Middle Aged ; Multivariate Analysis ; Neoplasm Recurrence, Local/immunology ; Neoplasm Recurrence, Local/virology ; Outcome Assessment (Health Care)/methods ; Outcome Assessment (Health Care)/statistics & numerical data ; Proportional Hazards Models ; Retrospective Studies ; Time Factors ; Transplantation, Homologous ; Virus Replication/immunology* ; Young Adult
Cytomegalovirus ; Chronic GVHD ; Hematopoietic stem cell transplantation ; Relapse
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.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Soo Jeong(김수정) ORCID logo https://orcid.org/0000-0001-8859-3573
Kim, Yu Ri(김유리) ORCID logo https://orcid.org/0000-0001-5505-0142
Kim, Yun Deok(김윤덕) ORCID logo https://orcid.org/0000-0002-5336-7936
Kim, Jin Seok(김진석) ORCID logo https://orcid.org/0000-0001-8986-8436
Min, Yoo Hong(민유홍) ORCID logo https://orcid.org/0000-0001-8542-9583
Jang, Ji Eun(장지은) ORCID logo https://orcid.org/0000-0001-8832-1412
Cheong, June-Won(정준원) ORCID logo https://orcid.org/0000-0002-1744-0921
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