The clinical and financial burden of pre-emptive management ofcytomegalovirus disease after allogeneic stem cell transplantation-implications for preventative treatment approaches

Natasha A. Jain, Kit Lu, Sawa Ito, Pawel Muranski, Christopher S. Hourigan, Janice Haggerty, Puja D. Chokshi, Catalina Ramos, Elena Cho, Lisa Cook, Richard Childs, Minoo Battiwalla, A. John Barrett

Research output: Contribution to journalArticle

Abstract

Background aims: Although cytomegalovirus (CMV) infection after allogeneic stem cell transplantation (SCT) is rarely fatal, the management of CMV by pre-emptive medication for viral reactivation has toxicity and carries a financial burden. New strategies to prevent CMV reactivation with vaccines and antiviral T cells may represent an advance over pre-emptive strategies but have yet to be justified in terms of transplantation outcome and cost. Methods: We compared outcomes and post-transplantation treatment cost in 44 patients who never required pre-emptive CMV treatment with 90 treated patients undergoing SCT at our institute between 2006 and 2012. Eighty-one subjects received CD34+ selected myeloablative SCT, 12 umbilical cord blood transplants, and 41 T-replete non-myeloablative SCT. One hundred nineteen patients (89%) were at risk for CMV because either the donor or recipient was seropositive. Of these, 90 patients (75.6%) reactivated CMV at a median of 30 (range 8-105) days after transplantation and received antivirals. Results: There was no difference in standard transplantation risk factors between the two groups. In multivariate modeling, CMV reactivation >250 copies/mL (odds ratio= 3, P< 0.048), total duration of inpatient IV antiviral therapy (odds ratio= 1.04, P< 0.001), type of transplantation (T-deplete vs. T-replete; odds ratio= 4.65, P< 0.017) were found to be significantly associated with increased non-relapse mortality. The treated group incurred an additional cost of antiviral medication and longer hospitalization within the first 6 months after SCT of $58,000 to $74,000 per patient. Conclusions: Our findings suggest that to prevent CMV reactivation, treatment should be given within 1 week of SCT. Preventative treatment may improve outcome and have significant cost savings.

Original languageEnglish (US)
Pages (from-to)927-933
Number of pages7
JournalCytotherapy
Volume16
Issue number7
DOIs
StatePublished - Jul 2014
Externally publishedYes

Keywords

  • Antiviral cellular therapy
  • CMV reactivation
  • Economic cost
  • Pre-emptive therapy

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Oncology
  • Genetics(clinical)
  • Cell Biology
  • Cancer Research
  • Transplantation

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  • Cite this

    Jain, N. A., Lu, K., Ito, S., Muranski, P., Hourigan, C. S., Haggerty, J., Chokshi, P. D., Ramos, C., Cho, E., Cook, L., Childs, R., Battiwalla, M., & Barrett, A. J. (2014). The clinical and financial burden of pre-emptive management ofcytomegalovirus disease after allogeneic stem cell transplantation-implications for preventative treatment approaches. Cytotherapy, 16(7), 927-933. https://doi.org/10.1016/j.jcyt.2014.02.010