Predictors for persistent cytomegalovirus reactivation after T-cell-depleted allogeneic hematopoietic stem cell transplantation Journal Article
| Authors: | Almyroudis, N. G.; Jakubowski, A.; Jaffe, D.; Sepkowitz, K.; Pamer, E.; O'Reilly, R. J.; Papanicolaou, G. A. |
| Article Title: | Predictors for persistent cytomegalovirus reactivation after T-cell-depleted allogeneic hematopoietic stem cell transplantation |
| Abstract: | Cytomegalovirus (CMV) reactivation occurs in up to 60% of CMV-seropositive recipients after allogeneic hematopoietic stem cell transplantation (HSCT). The incidence of CMV disease among T-cell-depleted HSCT patients has been reported from 5-15%. The incidence of reactivation refractory to antivirals in this population is not well studied. Methods. In this retrospective study we characterized the outcome of CMV reactivation in a cohort of 255 adult and pediatric patients who underwent T-cell-depleted HSCT at Memorial Sloan-Kettering Cancer Center from September 1999 through August 2004. CMV infection was monitored by the pp65 antigenemia assay (CMV Ag). Persistent reactivation was defined as antigenemia positivity >21 days on antiviral therapy. Results. Of 118 CMV-seropositive recipients, 69 (58.4%) had reactivated CMV. Twenty of 69 (29%) developed persistent reactivation at first episode of reactivation, and 7 (10%) in subsequent episode. All patients with persistent reactivation received ≥2 antivirals and CMV hyperimmune globulin; 45% received combination antiviral therapy. The median duration of persistent reactivation was 98 days, range 31-256 days. In multivariate analysis, maximum CMV Ag >25 cells/slide was associated with persistent reactivation (odds ratio 16.2%, 95% confidence interval 4-64, P<0.0001). CMV disease occurred in 6/27 (22%) patients with persistent reactivation. Patients with persistent reactivation had lower CD4+ and CD8+ lymphocyte counts compared with those with non-persistent reactivation at day +90 post HSCT (P=0.01 and 0.02, respectively). Conclusions. Persistent reactivation occurred in 39% of T-cell-depleted HSCT despite treatment with currently available antivirals. Maximum CMV Ag >25 cells/slide was associated with persistent CMV reactivation. More effective treatment modalities are needed for this high-risk population to reduce CMV-associated morbidity and mortality. Copyright © Blackwell Munksgaard 2007. |
| Keywords: | adolescent; adult; child; controlled study; treatment outcome; child, preschool; middle aged; transplantation, homologous; major clinical study; treatment duration; outcome assessment; cd8+ t lymphocyte; t-lymphocytes; disease association; clinical assessment; incidence; cohort analysis; risk factors; immunoglobulin; hematopoietic stem cell transplantation; retrospective study; prediction; risk factor; infant; cd4+ t lymphocyte; allogeneic hematopoietic stem cell transplantation; disease duration; immunoassay; multivariate analysis; serodiagnosis; t cell depletion; bone marrow transplantation; foscarnet; ganciclovir; cytomegalovirus infection; cytomegalovirus; lymphocyte depletion; graft recipient; lymphocyte count; virus reactivation; persistent infection; antiviral therapy; virus activation; antiviral agents; t-cell depleted; cytomegalovirus infections; cmv disease; cmv outcome; cytomegalovirus antibody; hyperimmune globulin |
| Journal Title: | Transplant Infectious Disease |
| Volume: | 9 |
| Issue: | 4 |
| ISSN: | 1398-2273 |
| Publisher: | Wiley Blackwell |
| Date Published: | 2007-12-01 |
| Start Page: | 286 |
| End Page: | 294 |
| Language: | English |
| DOI: | 10.1111/j.1399-3062.2007.00235.x |
| PUBMED: | 17511819 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | - "Export Date: 17 November 2011" - "CODEN: TIDSF" - "Source: Scopus" |
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273Sepkowitz -
283Pamer -
238Papanicolaou -
458Jakubowski -
748O'Reilly
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