Efficiency and Risk Factors for CMV Transmission in Seronegative Hematopoietic Stem Cell Recipients

Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA.
Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation (Impact Factor: 3.4). 02/2012; 18(9):1391-400. DOI: 10.1016/j.bbmt.2012.02.008
Source: PubMed


Cytomegalovirus (CMV) transmission via stem cells or marrow in CMV donor seropositive/recipient seronegative (D+/R-) hematopoietic cell transplantation (HCT) is surprisingly inefficient, and factors associated with transmission in these high-risk HCT recipients are unknown. In a retrospective cohort of D+/R- HCT recipients, cumulative incidence curve estimates were used to determine posttransplantation rates of CMV and multivariable Cox proportional models to assess risk factors associated with transmission. A total of 447 patients from 1995 to 2007 were eligible for enrollment. Overall, 85 of 447 (19.0%) acquired CMV at a median of 49 days (IQR 41-60) posttransplantation. CMV disease before day 100 occurred in 6 of 447 (1.3%) patients and in 7 of 447 (1.6%) after day 100. The donor graft, specifically the total nucleated cell count (adjusted hazard ratio [HR] 2.7; 95% confidence interval [CI], 1.4-4.7, P = .0002), was the only factor associated with CMV transmission in multivariable analyses. Notably, the source stem cells (marrow versus peripheral blood stem cell [PBSC]), screening method, and graft-versus-host disease (GVHD) were not associated with transmission. Thus, a highly cellular graft was the only identifiable risk factor associated with CMV transmission, suggesting that viral genomic content of the donor graft determines transmission efficiency in D+/R- HCT recipients.

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    • "If a CMV IgG-negative recipient receives cells from a CMV IgG-positive donor (R À /D + ) then CMV infection occurs in 20–30% of cases. CMV disease is unusual but NRM is increased, probably through the indirect effects of CMV on immune status post-transplant (Nichols et al, 2002; Ljungman et al, 2011; Pergam et al, 2012). There is a greater risk of CMV reactivation and progression to CMV disease in CMV seropositive recipients, where 80% are likely to reactivate CMV, irrespective of CMV status of donor (Ljungman et al, 2011). "

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