ArticleOpen forum infectious diseases2026
Pretransplant CMV-IgG Titers and DNAemia Are Associated With CMV Infections Post Allogeneic Hematopoietic Cell Transplant With or Without Letermovir.
Article in Open forum infectious diseases, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background: The impact of pretransplant cytomegalovirus (CMV) serology and DNAemia on posttransplant clinically significant CMV infections (csCMVi) in allogeneic hematopoietic cell transplant recipients (allo-HCTR) is poorly described. Methods: We performed a single-center cohort study of adult allo-HCTR (16 November 2015-31 December 2023). Letermovir prophylaxis was administered after 01 May 2019 during 100 days (d) posttransplant in CMV-seropositive patients (R+). We investigated associations of pretransplant CMV-IgG-titers and CMV-DNAemia with posttransplant csCMVi and CMV-DNAemia during 6 months posttransplant. In CMVR+, CMV-IgG-titers were classified as "low" (<40 IU/mL) or "high" (≥40 IU/mL). Quantitative CMV-PCR was performed pre-HCT, weekly for 3 months and as clinically indicated. Results: Among the 485 patients included, 209 and 276 underwent a first allo-HCT in the pre- and postletermovir periods, respectively; 314/485 (64.7%) patients were CMVR + . Patients with high CMV-IgG-titers had a higher incidence of csCMVi by d180 posttransplant (47.6%, 95% CI: 41.4-53.6) than those with low CMV-IgG-titers (22.5%, 95% CI: 11.5-35.7) and CMVR- (3.6%, 95% CI: 1.5-7.2, Conclusions: Pretransplant high CMV-IgG-titers and detectable/quantifiable DNAemia were associated with higher posttransplant csCMVi/CMV-DNAemia incidence, including in the letermovir era. Additional studies on the clinical utility of baseline pretransplant CMV burden in CMV prophylaxis stratification algorithms are needed.
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