A Predicted Model for Refractory/Recurrent Cytomegalovirus Infection in Acute Leukemia Patients After Haploidentical Hematopoietic Stem Cell Transplantation

Meng-Zhu Shen, Shen-Da Hong, Jie Wang, Xiao-Hui Zhang, Lan-Ping Xu, Yu Wang, Chen-Hua Yan, Huan Chen, Yu-Hong Chen, Wei Han, Feng-Rong Wang, Jing-Zhi Wang, Kai-Yan Liu, Xiao-Jun Huang, Xiao-Dong Mo, Meng-Zhu Shen, Shen-Da Hong, Jie Wang, Xiao-Hui Zhang, Lan-Ping Xu, Yu Wang, Chen-Hua Yan, Huan Chen, Yu-Hong Chen, Wei Han, Feng-Rong Wang, Jing-Zhi Wang, Kai-Yan Liu, Xiao-Jun Huang, Xiao-Dong Mo

Abstract

Objective: We aimed to establish a model that can predict refractory/recurrent cytomegalovirus (CMV) infection after haploidentical donor (HID) hematopoietic stem cell transplantation (HSCT).

Methods: Consecutive acute leukemia patients receiving HID HSCT were enrolled (n = 289). We randomly selected 60% of the entire population (n = 170) as the training cohort, and the remaining 40% comprised the validation cohort (n = 119). Patients were treated according to the protocol registered at https://ichgcp.net/clinical-trials-registry/NCT03756675" title="See in ClinicalTrials.gov">NCT03756675).

Results: The model was as follows: Y = 0.0322 × (age) - 0.0696 × (gender) + 0.5492 × (underlying disease) + 0.0963 × (the cumulative dose of prednisone during pre-engraftment phase) - 0.0771 × (CD34+ cell counts in graft) - 1.2926. The threshold of probability was 0.5243, which helped to separate patients into high- and low-risk groups. In the low- and high-risk groups, the 100-day cumulative incidence of refractory/recurrent CMV was 42.0% [95% confidence interval (CI), 34.7%-49.4%] vs. 63.7% (95% CI, 54.8%-72.6%) (P < 0.001) for total patients and was 50.5% (95% confidence interval (CI), 40.9%-60.1%) vs. 71.0% (95% CI, 59.5%-82.4%) (P = 0.024) for those with acute graft-versus-host disease. It could also predict posttransplant mortality and survival.

Conclusion: We established a comprehensive model that could predict the refractory/recurrent CMV infection after HID HSCT.

Clinical trial registration: https://ichgcp.net/clinical-trials-registry/NCT03756675" title="See in ClinicalTrials.gov">NCT03756675.

Keywords: cytomegalovirus; haploidentical donor; hematopoietic stem cell transplant; predicted model; refractory.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2022 Shen, Hong, Wang, Zhang, Xu, Wang, Yan, Chen, Chen, Han, Wang, Wang, Liu, Huang and Mo.

Figures

Figure 1
Figure 1
Flow diagram of building the machine learning model.
Figure 2
Figure 2
Receiver operating characteristic (ROC) curve and confusion matrix for refractory/recurrent cytomegalovirus (CMV) infection model in the training (A) and validation cohorts (B).
Figure 3
Figure 3
The 100-day cumulative incidence of refractory/recurrent (A) and total (B) cytomegalovirus (CMV) infection in the low- and high-risk groups.
Figure 4
Figure 4
The 100-day cumulative incidence of refractory/recurrent cytomegalovirus (CMV) infection in patients without acute graft-versus-host disease (aGVHD) (A) and with aGVHD (B).
Figure 5
Figure 5
The 1-year cumulative incidence of relapse (A), non-relapse mortality (NRM; B), leukemia-free survival (LFS; C), and overall survival (OS; D) in the low- and high-risk groups.

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