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Peer-reviewedCC BYZhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi

[The impact of collateral CMV-seropositive and CMV-seronegative donors on the outcomes of allogeneic hematopoietic stem cell transplantation].

  • J Liu1
  • Y Y Zhang1
  • X D Mo1
  • Y Q Sun1
  • M Lyu1
  • X Y Pei1
  • X S Zhao1
  • Y F Cheng1
  • H X Fu1
  • L P Xu1
  • X H Zhang1
  • X J Huang1
1 more authors
  • Y Wang1
  1. 1Peking University People's Hospital, Peking University Institute of Hematology, National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation for Hematologic Diseases, Beijing 100044, China.
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Abstract

Objective: To investigate the impact of collateral cytomegalovirus (CMV) -positive versus CMV-negative donors on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Method: This retrospective cohort study analyzed CMV-related events and survival outcomes in allo-HSCT recipients with CMV seropositive who received grafts from CMV-negative (CMV-negative donor group) or collateral CMV-positive (collateral CMV-positive donor group) haploidentical donors at Peking University People's Hospital from January 2017 to March 2025. Results: A total of 126 patients were enrolled, including 16 CMV-negative and 58 collateral CMV-positive donors before the availability of letermovir, and 27 CMV-negative and 25 collateral CMV-positive donors after the availability of letermovir. With a median follow-up of 1 091 (660, 1 536) days, before the availability of letermovir in China, the CMV-negative donor group had a significantly higher incidence of refractory CMV viremia (87.5% vs 50.0%, P=0.007) and a longer median duration of first CMV viremia [29 (95% CI: 25-33) vs 17 (95% CI: 15-19) days, P=0.004] than the collateral CMV-positive donor group. The use of letermovir significantly delayed the onset of first post-transplant CMV viremia in both groups: from day 37 (95% CI: 31-43) to day 140 (95%CI: 136-144) in the CMV-negative donor group (P<0.001) and from day 36 (95% CI: 33-39) to day 111 (95% CI: 76-146) in the collateral CMV-positive donor group (P=0.013). With letermovir prophylaxis, the difference in the median duration of the first CMV viremia between the CMV-negative and collateral CMV-positive donor groups was no longer significant [18 (95% CI: 17-19) vs 12 (95%CI: 0-25) days, P=0.313]. Letermovir reduced the incidence of refractory CMV viremia in the CMV-negative donor group (40.7% vs 87.5%, P=0.003), but the incidence remained higher than that in the collateral CMV-positive donor group (40.7% vs 12.0%, P=0.020). Regardless of letermovir use, there were no statistically significant differences in the 3-year overall survival, non-relapse mortality, or cumulative relapse rate between the CMV-negative and collateral CMV-positive donor groups (all P>0.05). Multivariate analysis showed that CMV disease was an independent risk factor for overall survival (HR=3.0, 95%CI: 1.3-7.3, P=0.014) and non-relapse mortality (HR=3.1, 95%CI: 1.1-8.8, P=0.035). Refractory CMV viremia was an independent risk factor for CMV disease (HR=12.0, 95%CI: 2.9-50.7, P=0.001). Logistic regression analysis showed that having a CMV-negative donor status without letermovir prophylaxis was an independent risk factor for refractory CMV viremia (P=0.005) . Conclusion: CMV-negative donors increase the risk of CMV-related events in recipients. Although letermovir prophylaxis mitigates this risk, the incidence of refractory CMV viremia remains higher in the CMV-negative donor group than in the collateral CMV-positive donor group, whereas the overall survival outcomes are comparable between the two donor sources.

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BibTeXRIS
BibTeX
@article{liu2026impact,
  title = {{[The impact of collateral CMV-seropositive and CMV-seronegative donors on the outcomes of allogeneic hematopoietic stem cell transplantation].}},
  author = {J Liu and Y Y Zhang and X D Mo and Y Q Sun and M Lyu and X Y Pei and X S Zhao and Y F Cheng and H X Fu and L P Xu and X H Zhang and X J Huang and Y Wang},
  journal = {Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi},
  year = {2026},
  month = aug,
  doi = {10.3760/cma.j.cn121090-20251016-00470},
  url = {https://europepmc.org/article/MED/42851177},
  note = {CC BY},
}
RIS
TY  - JOUR
TI  - [The impact of collateral CMV-seropositive and CMV-seronegative donors on the outcomes of allogeneic hematopoietic stem cell transplantation].
AU  - J Liu
AU  - Y Y Zhang
AU  - X D Mo
AU  - Y Q Sun
AU  - M Lyu
AU  - X Y Pei
AU  - X S Zhao
AU  - Y F Cheng
AU  - H X Fu
AU  - L P Xu
AU  - X H Zhang
AU  - X J Huang
AU  - Y Wang
PY  - 2026
DA  - 2026/08/01
JO  - Zhonghua xue ye xue za zhi = Zhonghua xueyexue zazhi
DO  - 10.3760/cma.j.cn121090-20251016-00470
UR  - https://europepmc.org/article/MED/42851177
AB  - Objective: To investigate the impact of collateral cytomegalovirus (CMV) -positive versus CMV-negative donors on the outcomes of allogeneic hematopoietic stem cell transplantation (allo-HSCT) . Method: This retrospective cohort study analyzed CMV-related events and survival outcomes in allo-HSCT recipients with CMV seropositive who received grafts from CMV-negative (CMV-negative donor group) or collateral CMV-positive (collateral CMV-positive donor group) haploidentical donors at Peking University People's Hospital from January 2017 to March 2025. Results: A total of 126 patients were enrolled, including 16 CMV-negative and 58 collateral CMV-positive donors before the availability of letermovir, and 27 CMV-negative and 25 collateral CMV-positive donors after the availability of letermovir. With a median follow-up of 1 091 (660, 1 536) days, before the availability of letermovir in China, the CMV-negative donor group had a significantly higher incidence of refractory CMV viremia (87.5% vs 50.0%, P=0.007) and a longer median duration of first CMV viremia [29 (95% CI: 25-33) vs 17 (95% CI: 15-19) days, P=0.004] than the collateral CMV-positive donor group. The use of letermovir significantly delayed the onset of first post-transplant CMV viremia in both groups: from day 37 (95% CI: 31-43) to day 140 (95%CI: 136-144) in the CMV-negative donor group (P<0.001) and from day 36 (95% CI: 33-39) to day 111 (95% CI: 76-146) in the collateral CMV-positive donor group (P=0.013). With letermovir prophylaxis, the difference in the median duration of the first CMV viremia between the CMV-negative and collateral CMV-positive donor groups was no longer significant [18 (95% CI: 17-19) vs 12 (95%CI: 0-25) days, P=0.313]. Letermovir reduced the incidence of refractory CMV viremia in the CMV-negative donor group (40.7% vs 87.5%, P=0.003), but the incidence remained higher than that in the collateral CMV-positive donor group (40.7% vs 12.0%, P=0.020). Regardless of letermovir use, there were no statistically significant differences in the 3-year overall survival, non-relapse mortality, or cumulative relapse rate between the CMV-negative and collateral CMV-positive donor groups (all P>0.05). Multivariate analysis showed that CMV disease was an independent risk factor for overall survival (HR=3.0, 95%CI: 1.3-7.3, P=0.014) and non-relapse mortality (HR=3.1, 95%CI: 1.1-8.8, P=0.035). Refractory CMV viremia was an independent risk factor for CMV disease (HR=12.0, 95%CI: 2.9-50.7, P=0.001). Logistic regression analysis showed that having a CMV-negative donor status without letermovir prophylaxis was an independent risk factor for refractory CMV viremia (P=0.005) . Conclusion: CMV-negative donors increase the risk of CMV-related events in recipients. Although letermovir prophylaxis mitigates this risk, the incidence of refractory CMV viremia remains higher in the CMV-negative donor group than in the collateral CMV-positive donor group, whereas the overall survival outcomes are comparable between the two donor sources.
SN  - 0253-2727
SN  - 2707-9740
ER  -