Cytomegalovirus infection after CD34(+)-selected hematopoietic cell transplantation Journal Article


Authors: Huang, Y. T.; Neofytos, D.; Foldi, J.; Kim, S. J.; Maloy, M.; Chung, D.; Castro-Malaspina, H.; Giralt, S. A.; Papadopoulos, E.; Perales, M. A.; Jakubowski, A. A.; Papanicolaou, G. A.
Article Title: Cytomegalovirus infection after CD34(+)-selected hematopoietic cell transplantation
Abstract: The effectiveness of preemptive treatment (PET) for cytomegalovirus (CMV) in recipients of ex vivo T cell-depleted (TCD) hematopoietic cell transplantation (HCT) by CD34(+) selection is not well defined. We analyzed 213 adults who received TCD-HCT at our institution from June 2010 through May 2014. Patients were monitored by a CMV quantitative PCR assay if recipient (R) or donor (D) were CMV seropositive. CMV viremia occurred early (median, 27 days after HCT) in 91 of 213 (42.7%) patients for a 180-day cumulative incidence of 84.5%, 61.8%, and 0 for R+/D+, R+/D-, and R-/D+ patients, respectively. CMV disease occurred in 5% of patients. In Cox regression analysis, R+/D+ status was associated with increased risk for CMV viremia compared with R+/D- (hazard ratio [HR], 1.79, 95% confidence interval [CI], 1.16 to 2.76, P =.01), whereas matched unrelated donor allograft was associated with decreased risk (HR, .62; 95% CI, .39 to .97, P =.04). Of 91 patients with CMV viremia, 52 (57%) had persistent viremia (>28 days duration). Time lag from detection of CMV viremia to PET was associated with incremental risk for persistent viremia (HR, 1.09; 95% CI, 1.01 to 1.18; P =.03). Overall, 166 of 213 (77.9%) patients were alive 1 year after HCT, with no difference between patients with and without CMV viremia or among the different CMV serostatus pairs (P = not significant). CMV viremia occurred in 70% of R + TCD-HCT. Delay in PET initiation was associated with persistent viremia. With PET, CMV R/D serostatus did not adversely impact survival in TCD-HCT on 1-year survival in the present cohort. (C) 2016 American Society for Blood and Marrow Transplantation.
Keywords: transplantation; hematopoietic cell; complications; epidemiology; t cell depletion; cytomegalovirus; disease; peripheral-blood; risk-factors; bone-marrow; reactivation; unrelated donors; preemptive therapy; cmv viremia; cmv-seropositive recipients; serostatus
Journal Title: Biology of Blood and Marrow Transplantation
Volume: 22
Issue: 8
ISSN: 1083-8791
Publisher: Elsevier Inc.  
Date Published: 2016-08-01
Start Page: 1480
End Page: 1486
Language: English
ACCESSION: WOS:000380417400021
DOI: 10.1016/j.bbmt.2016.05.003
PROVIDER: wos
PMCID: PMC4949094
PUBMED: 27178374
Notes: Article -- Source: Wos
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MSK Authors
  1. Sergio Andres Giralt
    648 Giralt
  2. Miguel-Angel Perales
    494 Perales
  3. Molly Anna Maloy
    191 Maloy
  4. Dick Chung
    13 Chung
  5. Yao-Ting Huang
    28 Huang
  6. Julia   Foldi
    4 Foldi
  7. Seong Jin   Kim
    12 Kim