Incidence, nature and mortality of cytomegalovirus infection after double-unit cord blood transplant

Leuk Lymphoma. 2015 Jun;56(6):1799-805. doi: 10.3109/10428194.2014.963079. Epub 2014 Oct 21.

Abstract

Cord blood transplant (CBT) extends allograft access but is associated with a significant risk for cytomegalovirus (CMV) infection. We analyzed CMV infection in 157 CBT recipients transplanted for hematological malignancies. As compared with antigenemia testing, routine polymerase chain reaction (PCR) monitoring was associated with increased and earlier CMV infection detection (1-year incidence if seropositive 67% [median onset 41 days] vs. 100% at an earlier 33-day median [p < 0.001]) and decreased gastrointestinal disease. One-year CMV-related transplant-related mortality was 11% in CMV+ patients with 7/9 deaths associated with initial infection. Disease-free survival was lower in seropositive compared with seronegative patients (1-year: 55% vs. 73%, p = 0.02). However, in multivariate analysis adjusting for age, treatment failure risk in CMV+ patients was not significant (hazard ratio 1.52, p = 0.11). CMV infection is a major challenge in seropositive CBT recipients. While PCR surveillance permits early detection of viremia, new prophylaxis and therapeutic strategies are needed.

Keywords: Allogeneic transplant; cord blood; cytomegalovirus; transplant-related mortality.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Child
  • Child, Preschool
  • Cord Blood Stem Cell Transplantation / adverse effects*
  • Cord Blood Stem Cell Transplantation / methods
  • Cytomegalovirus / genetics
  • Cytomegalovirus / isolation & purification*
  • Cytomegalovirus / physiology
  • Cytomegalovirus Infections / epidemiology
  • Cytomegalovirus Infections / etiology*
  • Cytomegalovirus Infections / virology
  • DNA, Viral / genetics
  • Disease-Free Survival
  • Gastrointestinal Diseases / etiology
  • Gastrointestinal Diseases / virology
  • Hematologic Neoplasms / therapy*
  • Humans
  • Incidence
  • Infant
  • Middle Aged
  • Multivariate Analysis
  • Outcome Assessment, Health Care / methods
  • Outcome Assessment, Health Care / statistics & numerical data
  • Pneumonia / etiology
  • Pneumonia / virology
  • Proportional Hazards Models
  • Viremia / blood
  • Viremia / virology
  • Young Adult

Substances

  • DNA, Viral