@article {574,
	title = {Pre-transplant cytomegalovirus (CMV) serostatus remains the most important determinant of CMV reactivation after allogeneic hematopoietic stem cell transplantation in the era of surveillance and preemptive therapy.},
	journal = {Transpl Infect Dis},
	volume = {12},
	year = {2010},
	month = {Aug},
	pages = {322 - 9},
	abstract = {Between January 2001 and June 2008, 315 adult patients (median age 43 years, range 16-65) including 203 males and 112 females undergoing hematopoietic stem cell transplantation (HSCT) had serial monitoring for cytomegalovirus (CMV) followed by initiation of preemptive therapy. The majority (62.1\%) had a conventional myeloablative transplant with 116 (36.9\%) having a reduced-intensity conditioning (RIC) transplant, using either matched sibling/family (63.3\%) or unrelated donors (36.7\%). Graft source was peripheral blood stem cells in 257 (81.5\%), bone marrow in 41 (13.1\%), and cord blood in 16 (5.4\%). T-cell depletion with anti-thymocyte globulin or alemtuzumab was used in 35\%. Based upon CMV serostatus, patients were classified into low risk (donor [D]-/recipient [R]-), intermediate risk (D+/R-), or high risk (D-/R+ or D+/R+). Serial weekly monitoring for CMV viremia was performed using a qualitative polymerase chain reaction (PCR) and when positive, quantification was done using either pp65 antigen or a quantitative PCR. CMV reactivation was seen in 123 patients (39.1\%) at a median of 50 days post HSCT (range 22-1978). CMV serostatus was the most important risk factor with incidence of 53\% in the high-risk group (53.3\%) compared with 10.2\% in the intermediate risk and 0\% in the low-risk group (P<0.0001). Other significant risk factors identified included use of alemtuzumab during conditioning (P=0.03), RIC transplants (P=0.06), and the presence of acute graft-versus-host disease (GVHD) (P<0.0001). On a multivariate analysis, CMV serostatus, RIC transplants, and acute GVHD remained independent predictors of CMV reactivation. All were treated with antiviral therapy with responses seen in 109 (88.6\%). Sixteen patients (13\%) developed CMV disease at a median of 59 days post HSCT (range 26 days-46 months), 8 of whom died. At a median follow up of 43 months (range 6-93), 166 patients (52.6\%) are alive with a significantly higher survival among patients without CMV reactivation (57.2\%) as compared with patients with CMV reactivation (45.5\%; P=0.049). CMV reactivation and disease remains a major problem in high-risk patients undergoing allogeneic HSCT. Novel prophylactic measures such as immunotherapy and drug prophylaxis need to be considered in this specific group of patients.},
	issn = {1399-3062},
	doi = {TID504 [pii] 10.1111/j.1399-3062.2010.00504.x},
	author = {George,B. and Pati,N. and Gilroy,N. and Ratnamohan,M. and Huang,G. and Kerridge,I. and Hertzberg,M. and Gottlieb,D. and Bradstock,K.}
}
