Extremely High Incidence of CMV-pp65 Antigenemia in ATLL Patients After Allogeneic Hematopoietic Stem Cell Transplantation

Cytomegalovirus (CMV) infection is one of significant factors contribute to morbidity and mortality in recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). Prevention and treatment of active CMV infection based on monitoring CMV-pp65 antigenemia test or CMV-DNA PCR assay have been done in this field. The patients of adult T-cell leukemia/lymphoma (ATLL) are usually in immunocompromised status and some reports suggested that CMV reactivation occur with higher frequency in ATLL patients than other hematological malignancy during their chemotherapy periods. However, to our knowledge, there were few reports about relationships between CMV-pp65 antigenemia and recipients of allo-HSCT in ATLL. Our institute is located in endemic areas of ATLL. Here we analyzed disease specific impact for incidence of CMV-pp65 antigenemia in our institute. There were 97 patients had been consecutively undergone allo-HSCT from November 2006 to May 2012 in Imamura Bun-in Hospital, Kagoshima, Japan. We excluded 12 patients from our study because of their early deaths before 30 days after HSCT or neutrophil recovery. The rest of 85 patients (52 males, 33 females) were analyzed. We statistically analyzed whether ATLL has disease specific significance with incidence of CMV-pp65 antigenemia after allo-HSCT. Median age was 52 yrs (19-69). Thirty seven ATLL patients and 48 non-ATLL patients were included respectively. There were 19 patients had been transplanted from sibling donors (7 BM, 12 PB) and 66 unrelated donors (56 BM, 10 CB), respectively. Sixty four patients received MAC regimen and 21 RIC before allo-HSCT, respectively. There were 68 patients (27 ATLL, 41 non-ATLL) who could be identified prevalence of CMV-IgG antibody before transplantation. There were no statistically significant differences between age >= 50 and < 50 patients about CMV-IgG antibody prevalence rate in ATLL patients. On the other hand it was shown that significantly higher prevalence of CMV-IgG antibody in young patients than in elder patients in non- ATLL (P=0,002). There were 63 (34 ATLL, 29 non-ATLL) out of 85 patients who were developed CMV-pp65 antigenemia, and 7 CMV related diseases (6 colitis, 1 pneumonia). Cumulative incidence of CMV-pp65 antigenemia were significantly higher in ATLL (91.9% vs 60.4%, P<0.001) and age >= 50 yrs patients (89.6% vs 54.1%, P=0.002), respectively. Almost two-thirds of patients who were developed CMV-pp65 antigenemia had been administered iv steroid within 10 days before onset. In multivariate analysis of 63 patients who were identified as having prevalence of CMV-IgG antibody before transplantation, ATLL (HR: 2.625, P=0.008), RIC (HR: 2.532, P=0.014) were significant factors for incidence of CMV-pp65 antigenemia, respectively. In conclusion, ATLL could be one of independent factors impacting for incidence of CMV-pp65 antigenemia.