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Relapse of Leukemia After Bone Marrow Transplantation: Cytomegalovirus Infection Has No Protective Effect

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Key Points

  • CMV is a common virus in the general population—more than 90% of adults are carriers. In healthy people, CMV infection usually goes unnoticed, although the virus remains with them in latency throughout their lives.
  • Reactivation of CMV after a transplant is quickly detected and easily treated by current antiviral drugs.
  • Death rates from infections other than CMV are higher in patients or donors infected with CMV.

Recent studies on a small number of patients with leukemia treated with bone marrow transplantation have suggested that the presence of the common cytomegalovirus (CMV) in patients or their donors may protect against relapse or even death after the transplant. A large international study published by Teira et al in the journal Blood, based on data from some 9,500 transplant patients in over 400 hospitals between 2003 and 2010, now shows the opposite.

“The original purpose of the study was to confirm that CMV infection may prevent leukemia relapse, prevent death, and become a major therapeutic tool for improving patient survival rates,” said Pierre Teira, MD, MSc, hematologist-oncologist and researcher at the mother-child research hospital CHU Sainte-Justine, Assistant Clinical Professor at the University of Montreal's Faculty of Medicine, and first author of the study. “However, we found the exact opposite. Our results clearly show that, despite significant progress made in the past 20 years in the fight against death directly related to CMV, the virus not only does not prevent leukemia relapse, but also remains a major factor associated with the risk of death. Monitoring of CMV after transplantation remains a priority for patients.”

Risk of CMV

CMV is a common virus in the general population. Indeed, more than 90% of adults are carriers. In healthy people, CMV infection usually goes unnoticed, although the virus remains with them in latency throughout their lives. However, in leukemia patients receiving bone marrow transplants, CMV infection increases the risk of death.

That said, reactivation of CMV after a transplant is quickly detected and easily treated by current antiviral drugs. “Deaths due to uncontrolled CMV reactivation are virtually zero in this study, so uncontrolled CMV reactivation is not what reduces survival rates after transplantation. The link between this common virus and increased risk of death remains a biologic mystery,” said Dr. Teira.

One possible explanation is that CMV decreases the ability of the transplant patient’s immune system to fight against other types of infection. This is supported by the fact that death rates from infections other than CMV are higher in patients or donors infected with CMV. For researchers, the next step is therefore to verify whether the latest generation of anti–CMV treatments can prevent both reactivation of the virus and weakening of the patient's immune system against other types of infection in the presence of CMV infection.

“CMV has a complex impact on the outcomes for transplant patients, and each year more than 30,000 patients around the world receive bone marrow transplants from donors. It is therefore essential for future research to better understand the role played by CMV after bone marrow transplantation and improve the chances of success of the transplant. This will help to better choose the right donor for the right patient,” concluded Dr. Teira.

The study was conducted using the Center for International Blood and Marrow Transplant Registry (CIBMTR), which collects all data relating to patients and their donors for transplants performed in more than 400 hospitals worldwide. The study was funded by the U.S. National Institutes of Health and the U.S. Health Resources and Services Administration, which support the CIBMTR.

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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