Yong MK, et al. - This study employed highly sensitive plasma DNA to characterize the risk and relationship of cytomegalovirus (CMV) reactivation post-hematopoietic stem cell transplant (HSCT) to invasive fungal disease (IFD) in the current era of CMV viral load monitoring. This study did not find any link between the peak viral load, detection of any level of viremia, as well as experiencing more than 1 episode of CMV reactivation and development of IFD. However, an association was observed between CMV reactivation in HSCT recipients in the post-transplant period and an increased risk of developing late-onset IFD.

• Experts performed a multicenter, retrospective, cohort study of consecutive patients undergoing allogeneic HSCT from January 2006 to December 2010 in Melbourne, Australia.
• They defined CMV reactivation as detection of plasma CMV DNA≥546IU/mL or development of CMV disease.
• As per current international consensus guidelines, IFD was classified.
• The median age was 44 years (IQR, 34 to 54), and CMV reactivation occurred in 106 participants (25%) at a median time of 56 days (IQR, 45 to 79), among the 419 study participants.
• At a median time of 76 days (IQR, 24 to 344), thirty-eight participants (9.1%) were identified with 41 cases of IFD (n=22 proven, n=8 probable, n=11 possible).
• Results reported higher incidence of IFD in participants with CMV reactivation compared with no CMV reactivation (15% versus 7%, P=.012).
• CMV reactivation remained an independent risk factor for IFD (hazard ratio, 3.7; 95% CI, 1.6 to 8.5; P=.002), in a multivariate analysis.
• In addition, the cumulative incidence of all IFD in patients with and without CMV reactivation using a competing risk regression was a hazard ratio of 2.2 (95% CI, 1.2 to 4.1; P=.017) and for late-onset IFD was a hazard ratio of 3.95 (95% CI, 1.7 to 9; P=.001).
• Data demonstrated longer median time to IFD onset in participants with than without CMV reactivation (184 versus 37 days, P=.03).