Clinical impact of multiple DNA virus infections in nondepleted haploidentical and unrelated allogeneic hematopoietic stem cell transplantation

Few studies have compared the clinical impact of multiple DNA‐virus infections in haploidentical hematopoietic stem cell transplantation (haplo‐HSCT) with posttransplant cyclophosphamide (PTCy) and unrelated donor allogeneic hematopoietic stem cell transplantation (UD‐HSCT) with thymoglobulin, so we retrospectively analyzed viral infections in the first 6 mo posttransplant in these scenarios. Fifty‐nine patients underwent to haplo‐HSCT, and 68 to UD‐HSCT. The most frequent infection was cytomegalovirus (CMV) (76.3% in haplo‐HSCT and 69.1% in UD‐HSCT) (P = .878) and in the group of patients with CMV reactivation, maximal CMV viral load over 2500 UI/ml correlated with worse overall survival‐hazard ratio (HR) 1.93 (95% confidence interval [CI] 1.04‐3.59) P = .03. The cumulative incidence of multiple DNA virus within 180 d of posttransplant was 78.7% for one virus and 28.4% for two or more viruses with no difference regarding the type of transplant. Viral infections, age, and acute graft versus host disease (GVHD) grades II–IV were risk factors for worse overall survival in multivariate analyses: one virus HR 2.53 (95% CI 1.03‐6.17) P = .04, two or more viruses HR 3.51 (95% CI 1.37‐9) P