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Pre-engraftment Cytomegalovirus DNAemia after allogeneic hematopoietic stem cell transplantation and its impact on engraftment

Bone Marrow Transplantation volume 57, pages 289–291 (2022)Cite this article

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Cytomegalovirus (CMV) infection leads to high morbidity in patients undergoing allogeneic stem cell transplantation (allo-HCT) [1, 2]. Monitoring CMV DNAemia, preemptive antiviral therapies (PET) to prevent tissue-invasive disease and recently letermovir prophylaxis are the standard of care for these patients [3,4,5]. Letermovir prophylaxis is recommended to start with the first 30 days after transplantation, but some patients develop a very early CMV DNAemia, sometimes before engraftment [1, 2]. Recently, Solano et al. published a large multicenter study addressing pre-engraftment CMV DNAemia [6]. They showed that patients who developed pre-engraftment CMV DNAemia had more episodes of CMV recurrences than those with post-CMV DNAemia, but no impact in overall survival was found [6]. In their study, time to engraftment was not addressed as an outcome. Ganciclovir has significant adverse effects, including myelotoxicity, and CMV itself is a well-known myelotoxic pathogen [3, 5]. This study addressed the impact on engraftment time in HCT patients who developed pre-engraftment CMV DNAemia.

In an observational retrospective cohort, we included consecutive adult patients who underwent Allo-HCT at a single center between 2016 and 2020. CMV-seronegative recipients allografted with CMV-seronegative donors, those receiving anti-CMV prophylaxis, or patients who died before D+30 after transplant were excluded. The study received the local Institutional Review Board approbation.

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Authors and Affiliations

  1. Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brazil

    Marcia Garnica, Sylvia Dalcolmo, Bianca Gaio, Maria Claudia Moreira & Angelo Maiolino

  2. Complexo Hospitalar de Niterói – DASA, Niterói, Brazil

    Marcia Garnica, Sylvia Dalcolmo, Andreia Ribeiro de Almeida, Juliana Rivello, Ricardo Bigni, Marcia Rejane Valentim & Maria Claudia Moreira

  3. Instituto Nacional do Cancer, Rio de Janeiro, Brazil

    Ricardo Bigni & Maria Claudia Moreira

  4. Instituto COI de Ensino e Pesquisa, Rio de Janeiro, Brazil

    Angelo Maiolino

Authors
  1. Marcia Garnica
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  2. Sylvia Dalcolmo
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  3. Bianca Gaio
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  8. Maria Claudia Moreira
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Contributions

MG and AM conceived the study, performed the statistical analyses, interpreted the data, and wrote the paper; SD, BG, ARdA, and JR were involved in data collection. SD, MRV, RB, and MCM reviewed the paper and contributed to the final draft. All authors read and approved the final manuscript.

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Correspondence to Marcia Garnica.

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The authors declare no competing interests.

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Garnica, M., Dalcolmo, S., Gaio, B. et al. Pre-engraftment Cytomegalovirus DNAemia after allogeneic hematopoietic stem cell transplantation and its impact on engraftment. Bone Marrow Transplant 57, 289–291 (2022). https://doi.org/10.1038/s41409-021-01520-6

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