A comparison of filtered leukocyte-reduced and cytomegalovirus (CMV) seronegative blood products for the prevention of transfusion- associated CMV infection after marrow transplant [see comments]

Abstract

We performed a prospective, randomized trial in CMV seronegative marrow recipients to determine if filtered blood products were as effective as CMV-seronegative blood products for the prevention of transfusion- transmitted CMV infection after marrow transplant. Before transplant, 502 patients were randomized to receive either filtered or seronegative blood products. Patients were monitored for the development of CMV infection and tissue-documented CMV disease between days 21 and 100 after transplant. Infections occurring after day 21 from transplant were considered related to the transfusion of study blood products and, thus, were considered evaluable infections for the purpose of this trial. In the primary analysis of evaluable infections, there were no significant differences between the probability of CMV infection (1.3% v 2.4%, P = 1.00) or disease (0% v 2.4%, P = 1.00) between the seronegative and filtered arms, respectively, or probability of survival (P = .6). In a secondary analysis of all infections occurring from day 0 to 100 post-transplant, although the infection rates were similar, the probability of CMV disease in the filtered arm was greater (2.4% v 0% in the seronegative arm, P = .03). However, the disease rate was still within the prestudy clinically defined acceptable rate of < or = 5%. We conclude that filtration is an effective alternative to the use of seronegative blood products for prevention of transfusion- associated CMV infection in marrow transplant patients.

The impact of transfusion of leucodepleted platelet concentrates on cytomegalovirus disease after allogeneic stem cell transplantation

“…Where the prevalence of CMV is > 90% the provision of CMV-seronegative BCs is impractical. CMV is a leucocyte-associated virus and evidence suggests that leucodepletion may protect patients from CMV disease (Graan-Hentzen et al, 1989;Bowden et al, 1995).…”

Defining the Risks for Cytomegalovirus Infection and Disease After Solid Organ Transplantation

“…This atypical pattern of infection may be related to transmission of cytomegalovirus infection through transfusion of blood products, manifestation of false-negative cytomegalovirus serology in the hemodiluted donor, or through natural transmission in the community. 51,52 One method of effectively reducing the risk for primary cytomegalovirus infection is protective matching, which is the practice of transplanting an organ from a cytomegalovirus-seronegative donor to a seronegative recipient. Although protective matching may not be logistically feasible in most instances, it may be used in selected situations, including pediatric recipients and cytomegalovirus-seronegative recipients of intestinal and lung transplants.…”

Évolution des techniques de préparation des produits sanguins labiles (PSL) : inactivation des pathogènes dans les PSL

“…Ces méthodes sont donc efficaces pour la réduction du risque de transmission des virus lymphotropes tels que le CMV, l'Human T lymphotropic Virus I/II (HTLV-I/II), l'Epstein Barr Virus (EBV). L'efficacité de la déleucocytation par filtration des produits sanguins labiles dans le cadre de la transmission du CMV est cliniquement établie [11,12]. Il est démontré que le risque de transmission de l'HTLV-I/II est également réduit par l'utilisation de produits déleucocytés [13].…”