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Cytomegalovirus replication reduces the relapse incidence in patients with acute myeloid leukemia

Ahmet H. Elmaagacli and Michael Koldehoff

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  • RE: Response to Elmaagacli and Koldehoff
    • Minoo Battiwalla, Hematologist Hematology Branch, National Heart, Lung, and Blood Institute
    • Other Contributors:
      • Marcie L. Riches, Hematologist
      • Muthalagu Ramanathan, Hematologist
      • Kwang Woo Ahn, Statistician
      • Min Chen, Statistician
      • Pierre Teira, Hematologist

    On behalf of the Infection and Immune Reconstitution Working Committee of the Center for International Blood & Marrow Transplant Research

    We appreciate the interest from Elmaagacli and Koldehoff1 in the CIBMTR registry analysis2 demonstrating the persistent negative impact of cytomegalovirus (CMV) reactivation on non-relapse mortality and on overall survival after allogeneic hematopoietic cell transplantation (HCT) in the current era.  Our analysis of 9,469 patients showed that CMV reactivation had no preventive effect on hematologic disease relapse irrespective of diagnosis (including 5,310 subjects with AML). Moreover, CMV reactivation was associated with higher non-relapse mortality and reduced overall survival across subgroups.

    Prior to our analysis there had been several single-center studies that suggested that early CMV reactivation post transplant could reduce the risk of AML relapse. However, the meta-analysis presented by Elmaagacli and Koldehoff needs to be interpreted with caution. First, these are all retrospective studies and susceptible to a publication bias. Two of the six studies in Table 1 used the Fine and Gray model and four out of the six studies used the cause-specific hazards model. Although they fit competing risks data, they are two different models and thus their interpretation is also different. Therefore, summarizing the six studies using meta-analysis might not be appropriate. Without knowing the m...

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    Conflict of Interest:
    None declared.