TY - JOUR
T1 - The clinical and financial burden of pre-emptive management ofcytomegalovirus disease after allogeneic stem cell transplantation-implications for preventative treatment approaches
AU - Jain, Natasha A.
AU - Lu, Kit
AU - Ito, Sawa
AU - Muranski, Pawel
AU - Hourigan, Christopher S.
AU - Haggerty, Janice
AU - Chokshi, Puja D.
AU - Ramos, Catalina
AU - Cho, Elena
AU - Cook, Lisa
AU - Childs, Richard
AU - Battiwalla, Minoo
AU - Barrett, A. John
N1 - Funding Information:
This work was supported by the intramural research program of the National Heart, Lung, and Blood Institute, National Institutes of Health.
PY - 2014/7
Y1 - 2014/7
N2 - 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.
AB - 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.
KW - Antiviral cellular therapy
KW - CMV reactivation
KW - Economic cost
KW - Pre-emptive therapy
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U2 - 10.1016/j.jcyt.2014.02.010
DO - 10.1016/j.jcyt.2014.02.010
M3 - Article
C2 - 24831837
AN - SCOPUS:84901985882
SN - 1465-3249
VL - 16
SP - 927
EP - 933
JO - Cytotherapy
JF - Cytotherapy
IS - 7
ER -