Incidence and outcome of cytomegalovirus infections following nonmyeloablative compared with myeloablative allogeneic stem cell transplantation, a matched control study

Abstract

. Matching criteria included CMV risk group, HSC source, donor type, age, and underlying diseases. No CMV disease occurred in the low (donor and recipient serologically negative) and intermediate (donor serologically positive and recipient negative) CMV risk groups during the first 100 days. Among cases at high risk for CMV (seropositive recipients), trends to less CMV antigenemia (P ‫؍‬ .11), viremia (P ‫؍‬ .16), and disease (P ‫؍‬ .08) compared with controls were observed; all severe manifestations combined (CMV viremia and disease) were significantly reduced among cases (P ‫؍‬ .01). However, by day 365, the overall incidence of CMV disease became similar in both groups. The onset of CMV disease was significantly delayed among case patients compared with controls (median, 130 days versus 52 days; P ‫؍‬ .02). It was concluded that CMV disease was significantly delayed in nonmyeloablative cases, but that the overall 1-year incidence was similar to myeloablative HSCT patients. Therefore, nonmyeloablative HSCT patients should receive CMV surveillance beyond day 100 and preemptive ganciclovir treatment similar to that of myeloablative HSCT patients. (Blood. 2002;99:1978-1985

Fewer infections and lower infection-related mortality following non-myeloablative versus myeloablative conditioning for allotransplantation of patients with lymphoma

“…9,11,16,23,25 The recipient's CMV serostatus, the major determinant for CMV reactivation was positive in 45-60% of patients, which is similar to the recent report 26 and reflects the prevalence in our patient population. The difference in CMV reactivation adjusted for serostatus was of marginal significance in the subgroup of CMV seropositive recipients.…”

“…[1][2][3][4][5] Infections are frequent complications following HSCT and vary widely with the donor type, conditioning regimen, the immunosuppressive therapy used to prevent and treat GVHD as well as host factors such as age, underlying malignancy and presence of comorbidities. [6][7][8][9][10][11][12] Non-myeloablative (NMA) conditioning has been explored to decrease acute toxicities and shorten neutropenia and yet maintain a GVL effect. [5][6][7][8][9][10][11][12][13][14][15][16] The wider use of NMA regimens allows patients with less than adequate organ function, preceding fungal infections, or older age to receive allografts.…”

“…The results of published analyses of infections following allografts vary widely and are largely limited to cohorts of patients with heterogeneous diseases. [7][8][9]11,12,16,17 We examined the differences in etiologies and timing of bacterial, viral and fungal infections and their risk factors in 141 patients with lymphoma after either NMA or MA conditioning allografts. 5 …”

Epidemiologic Analysis of Reactivated Cytomegalovirus Antigenemia in Patients with Cancer

“…CMV reactivation is a common and severe problem in organ and stem cell transplant (SCT) recipients and in those infected with human immunodeficiency virus (HIV), particularly before the era of effective antiretroviral therapy. Among SCT recipients, the rate of CMV reactivation in the bloodstream (antigenemia or viremia) has been reported to be from 30% to 70% (2,11,13). Routine monitoring of CMV antigenemia by testing for the CMV pp65 antigen (or other means) has played a crucial role in detecting the virus and guiding effective antiviral therapy in SCT recipients (4,16).…”

Isolation in the allogeneic transplant environment: how protective is it?

“…The overall risk of CMV disease was also similar between these groups, but was delayed in onset among recipients of reduced-intensity transplants (median day þ 130 vs day þ 52). 5 The epidemiology of invasive fungal infections has also changed, reflecting the use of antifungal prophylaxis as well as changes in conditioning regimens. There has been a reduction in the incidence of Candida infections, but a relative increase in non-Albicans species, often resistant to fluconazole.…”