Cytomegalovirus Infection Post-hematopoietic Stem Cell Transplant: Incidence, Risk Factors, and Outcome in an Omani Cohort

Fatma Al Farsi; Khuloud Al Maamari; Fatma Ba Alawi; Murtadha Al-Khabori; David Dennison; Abdullah Al Busaidi; Iman Al Manthari

doi:10.5001/omj.2023.113

Cytomegalovirus Infection Post-hematopoietic Stem Cell Transplant: Incidence, Risk Factors, and Outcome in an Omani Cohort

Oman Med J. 2023 Nov 30;38(6):e567. doi: 10.5001/omj.2023.113. eCollection 2023 Nov.

Authors

Fatma Al Farsi¹, Khuloud Al Maamari², Fatma Ba Alawi², Murtadha Al-Khabori³, David Dennison³, Abdullah Al Busaidi¹, Iman Al Manthari⁴

Affiliations

¹ Medical Microbiology Residency Training Program, Oman Medical Specialty Board, Muscat, Oman.
² Department of Microbiology and Immunology, Sultan Qaboos University Hospital, Muscat, Oman.
³ Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman.
⁴ Department of Nursing, Sultan Qaboos University Hospital, Muscat, Oman.

Abstract

Objectives: To estimate the incidence, risk factors, and outcome of cytomegalovirus (CMV) infection during the first year following hematopoietic stem cell transplant (HSCT) among Omani patients.

Methods: This retrospective study included allogenic HSCT recipients between January 2006 and December 2018. We investigated the possible factors associated with CMV infection and CMV impact on one-year mortality.

Results: Among 556 recipients of allogenic HSCT, 308 (55.4%) were male, the median age was 12 years, and 366 (65.8%) had benign conditions. One-year after transplants, the prevalence of CMV infection was 59.4%, and that of CMV disease was 1.8%. Multivariate analyses revealed significant relationships between CMV infection and haploidentical transplant (p = 0.006), graft versus host disease (p = 0.013), myeloablative conditioning (p = 0.001), and patient age ≥ 12 years (p < 0.001). CMV infection was associated with an increased risk of one-year mortality (p = 0.001). One-year overall mortality was 8.3%.

Conclusions: The incidence of CMV infection in this Omani cohort was comparable with earlier findings, but the disease incidence and overall mortality were lower. Older age, haploidentical transplant, myeloablative conditioning, and graft versus host disease were significantly associated with a higher risk of CMV infection. In addition, CMV infection was associated with an increased risk of overall mortality in the first year post-transplant. Our findings support early initiation of preemptive therapy at low-level CMV viremia.

Keywords: Bone Marrow Transplantation; Cytomegalovirus; Graft Versus Host Disease; Mortality; Oman.