Re: Schelfhout J, Bonafede M, Cappell K, et al. Impact of cytomegalovirus complications on resource utilization and costs following hematopoietic stem cell transplant. Curr Med Res Opin. 2020; 36(1):33–41. Schelfhout J, Brown H, House JA, Raval AD. Cytomegalovirus infection and associated hospitalization and costs among individuals undergoing allogeneic hematopoietic stem cell transplant. Curr Med Res Opin. 2020;36(1):43–50.
The articles by Schelfhout et al.Citation1,Citation2 focus on the impact of Cytomegalovirus (CMV) infections in patients who undergo allogeneic hematopoietic stem cell transplantation (AHCT) in terms of increased costs. CMV-related readmissions have been one of the major concerns of transplant centres despite prophylaxis and weekly CMV DNA monitoring. Pre-emptive treatment of CMV, as well as treatment of overt CMV disease have been the focus of recent studiesCitation1–3.
In our transplantation centre, the data of 80 patients who underwent AHCT were evaluated retrospectively. Mean age was 44.7 years (range: 19–69); 30 patients were female while 50 were male (37.5/62.5%). Primary diseases of patients were acute leukaemia in 54 patients, lymphoma in 9 patients, myeloma in 6 and AA/MF/MDS in 11 patients. All patients were CMV seropositive before transplantation and received antiviral prophylaxis with valacyclovir and/or ganciclovir; 20 patients received reduced intensity conditioning (RIC) while 60 received myeloablative conditioning treatment. Five patients had bone marrow derived stem cells while 75 had peripheral blood stem cells. Sixty one patients underwent full match sibling AHCT while 7 had unrelated full match, 7 unrelated and with mismatch and 5 haploidentical AHCT. CMV reactivation was observed in 51 patients (63.7%).
Regarding the burden of CMV reactivation, mean hospitalization days for CMV treatment was 15.5 days (range: 1–71). Mean survival in patients with CMV reactivation was 45.5 months while in patients who did not develop reactivation, it was 36.7 months; this difference was not significant. Age, gender, primary disease, conditioning regimen, source of HCT were not related with reactivation. Despite prophylaxis, in the reactivated group, first CMV DNAemia levels were significantly higher (mean: 2442.2 IU/mL) which may be regarded as a warning.
In conclusion, CMV should be prevented from reactivating. Reactivation brings extra hospitalizations with significant treatment-related toxicity. Prophylactic approaches are needed, with oral drugs for patients to take at home. These drugs need to be less toxic to renal function and graft regeneration and, last but not least, less costly.
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All authors declare that they have no conflicts of interest. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.
Acknowledgements
None reported.
References
- Schelfhout J, Brown H, House JA, et al. Cytomegalovirus infection and associated hospitalization and costs among individuals undergoing allogeneic hematopoietic stem cell transplant. Curr Med Res Opin. 2019;23:1–8.
- Schelfhout J, Bonafede M, Cappell K, et al. Impact of cytomegalovirus complications on resource utilization and costs following hematopoietic stem cell transplant. Curr Med Res Opin. 2019;23:1–9.
- El Haddad L, Ghantoji SS, Park AK, et al. Clinical and economic burden of pre-emptive therapy of cytomegalovirus infection in hospitalized allogeneic hematopoietic cell transplant recipients. J Med Virol. 2020;92(1):86–95.