Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience.

Abstract

The aim of this study was to analyse the incidence and risk factors for cytomegalovirus infection (CMV-I) and disease (CMV-D) after a reduced intensity conditioning allogeneic hematopoietic stem cell transplantation (alloHSCT-RIC). We included 186 consecutive alloHSCT-RIC adult patients at risk for CMV reactivation (patient and/or donor CMV seropositivity). Conditioning regimen was based on fludarabine plus an alkylating agent. For guiding pre-emptive anti-CMV therapy, Pp65 Antigenemia (pp65Ag) (n=116) or quantitative polymerase chain reaction (quantPCR) (n=70) were used. The 2-year incidence of CMV-I and/or CMV-D was 36% (11% for CMV-D). Of note, 12/14 (86%) episodes of CMV-D in the pp65Ag group had lung involvement compared with only 3/15 (20%) in the quantPCR group (P=0.01). Importantly, the number of patients who developed CMV pneumonia with prior negative screening tests was unusually high (67% overall). Multivariate analysis of risk factors for CMV-D identified two risk factors: (i) steroid therapy for moderate-to-severe graft-vs-host disease (GVHD) (hazard ratio 4.7, P=0.02); and (ii) alternative donors (non-HLA-identical siblings) [hazard ratio 2.7, P=0.002]. Our findings suggest that CMV is still a major concern in alloHSCT-RIC. Variables associated with poor anti-CMV T-cell recovery (that is, GVHD and donor type) are helpful in identifying patients at higher risk for CMV-D in the alloHSCT-RIC setting.

• Authors: J L Piñana, R Martino, P Barba, N Margall, M C Roig, D Valcárcel, J Sierra, N Rabella
• Journal: Bone marrow transplantation (Bone Marrow Transplant) Vol. 45 Issue 3 Pg. 534-42 (Mar 2010) ISSN: 1476-5365 [Electronic] England
• PMID: 19668235 (Publication Type: Clinical Trial, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• Antigens, Viral
• Antiviral Agents
• Phosphoproteins
• Viral Matrix Proteins
• cytomegalovirus matrix protein 65kDa

Topics

• Adolescent
• Adult
• Aged
• Antigens, Viral (blood)
• Antiviral Agents (therapeutic use)
• Cytomegalovirus (genetics, immunology, isolation & purification)
• Cytomegalovirus Infections (etiology, prevention & control)
• Female
• Hematopoietic Stem Cell Transplantation (adverse effects)
• Humans
• Male
• Middle Aged
• Opportunistic Infections (etiology, prevention & control)
• Phosphoproteins (blood)
• Pneumonia, Viral (etiology, prevention & control)
• Retrospective Studies
• Risk Factors
• Transplantation Conditioning (methods)
• Transplantation, Homologous
• Viral Matrix Proteins (blood)
• Young Adult