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Blood, 15 July 2007, Vol. 110, No. 2, pp. 490-500. Prepublished online as a Blood First Edition Paper on March 28, 2007; DOI 10.1182/blood-2007-01-069294. This Article Full Text Full Text (PDF) All Versions of this Article: blood-2007-01-069294v1 110/2/490    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Marty, F. M. Articles by Baden, L. R. Search for Related Content PubMed PubMed Citation Articles by Marty, F. M. Articles by Baden, L. R. Related Collections Immunobiology Transplantation Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  CLINICAL TRIALS AND OBSERVATIONS Sirolimus-based graft-versus-host disease prophylaxis protects against cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation: a cohort analysis Francisco M. Marty1,3,4, Julie Bryar1, Sarah K. Browne1,4, Talya Schwarzberg1,4, Vincent T. Ho2,4, Ingrid V. Bassett1,4, John Koreth2,4, Edwin P. Alyea2,4, Robert J. Soiffer2,4, Corey S. Cutler2,4, Joseph H. Antin2,4, and Lindsey R. Baden1,3,4 1 Division of Infectious Diseases 2 Division of Medical Oncology, Brigham & Women's Hospital; 3 Dana-Farber Cancer Institute; 4 Harvard Medical School, Boston, MA Sirolimus-based immunosuppressive regimens in organ transplantation have been associated with a lower than expected incidence of cytomegalovirus (CMV) disease. Whether sirolimus has a similar effect on CMV reactivation after allogeneic hematopoietic stem cell transplantation (HSCT) is not known. We evaluated 606 patients who underwent HSCT between April 2000 and June 2004 to identify risk factors for CMV reactivation 100 days after transplantation. The cohort included 252 patients who received sirolimus-tacrolimus for graft-versus-host disease (GVHD) prophylaxis; the rest received non–sirolimus-based regimens. An initial positive CMV DNA hybrid capture assay was observed in 225 patients (37.1%) at a median 39 days after HSCT for an incidence rate of 0.50 cases/100 patient-days (95% confidence interval [CI], 0.44-0.57). Multivariable Cox modeling adjusting for CMV donor-recipient serostatus pairs, incident acute GVHD, as well as other important covariates, confirmed a significant reduction in CMV reactivation associated with sirolimus-tacrolimus–based GVHD prophylaxis, with an adjusted HR of 0.46 (95% CI, 0.27-0.78; P = .004). The adjusted HR was 0.22 (95% CI, 0.09-0.55; P = .001) when persistent CMV viremia was modeled. Tacrolimus use without sirolimus was not significantly protective in either model (adjusted HR, 0.66; P = .14 and P = .35, respectively). The protective effect of sirolimus-containing GVHD prophylaxis regimens on CMV reactivation should be confirmed in randomized trials. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: M. Boeckh and P. Ljungman How we treat cytomegalovirus in hematopoietic cell transplant recipients Blood, June 4, 2009; 113(23): 5711 - 5719. [Abstract] [Full Text] [PDF] P. Armand, S. Gannamaneni, H. T. Kim, C. S. Cutler, V. T. Ho, J. Koreth, E. P. Alyea, A. S. LaCasce, E. D. Jacobsen, D. C. Fisher, et al. Improved Survival in Lymphoma Patients Receiving Sirolimus for Graft-Versus-Host Disease Prophylaxis After Allogeneic Hematopoietic Stem-Cell Transplantation With Reduced-Intensity Conditioning J. Clin. Oncol., December 10, 2008; 26(35): 5767 - 5774. [Abstract] [Full Text] [PDF] C. Cutler, K. Stevenson, H. T. Kim, P. Richardson, V. T. Ho, E. Linden, C. Revta, R. Ebert, D. Warren, S. Choi, et al. Sirolimus is associated with veno-occlusive disease of the liver after myeloablative allogeneic stem cell transplantation Blood, December 1, 2008; 112(12): 4425 - 4431. [Abstract] [Full Text] [PDF] T. Zenz, A. Krober, K. Scherer, S. Habe, A. Buhler, A. Benner, T. Denzel, D. Winkler, J. Edelmann, C. Schwanen, et al. Monoallelic TP53 inactivation is associated with poor prognosis in chronic lymphocytic leukemia: results from a detailed genetic characterization with long-term follow-up Blood, October 15, 2008; 112(8): 3322 - 3329. [Abstract] [Full Text] [PDF]

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