Retrospective assessment of cytomegalovirus (CMV) infection risk factors in hematologic malignancies patients undergoing allogeneic hematopoietic stem cell transplantation

Introduction and purpose: The risk of CMV infection after AHSCT reaches 30-50%, and CMV infections that develop after transplantation are the most important cause of viral morbidity and mortality. In our study, it was aimed to investigate the risk factors affecting the development of CMV infection. Materials and Methods: One hundred ninty siz patients with hematological malignancies who underwent AHSCT in the Inonu University Faculty of Medicine Stem Cell Transplantation Unit over a 5-year period were retrospectively analyzed. Propensity score was calculated for the gender and age variables of those with CMV infection and the control group, and they were matched 1:1. CMV PCR test results, which were analyzed with QIAGEN kits, and patient information were accessed from the automation system. The analyzes were evaluated in 22 package programs of SPSS (Statistical Package for Social Sciences; SPSS Inc., Chicago, IL). Results: Of the 196 cases included in the study, 75 (38.3%) were female and 121 (61.7%) were male. The median age was 46 (17-71) in the CMV positive group and 47 (19-70) in the CMV negative group. CMV positivity of the cases was found positive on the median 39th day after transplantation. While the incidence of CMV infection was observed more frequently in ALL patients than in AML patients (p=0,012), the preparation regimen (p=1) did not affect the outcome in terms of risk. CMV positivity rate was high in patients with late neutrophil and platelet engraftment (p=0,011, p=0,041, respectively). The blood cyclosporine value measured simultaneously with CMV positivity was found to be significant in terms of risk (p=0,006). The rate of CMV infection was significantly higher in the group of patients with lymphocyte value <500, who were checked simultaneously with CMV positivity (p=0,021). A significant correlation was found between GVHD and CMV infection (p<0,001). A significantly higher rate of CMV infection was observed in patients with BK virus positivity who were started on cidofovir for hemorrhagic cystitis (p=0,002). Conclusion: Early diagnosis and treatment are of great importance as CMV infection is an important cause of prolonged hospital stay, morbidity and mortality in patients with AHSCT. In this study, we found a significant relationship between CMV infection, immunosuppressive therapy, GVHD, hematological malignancy, and delayed engraftment time. We think that these factors will shed light on the formation of a universal scoring system with new studies for CMV prophylaxis and early diagnosis and treatment of CMV infection.