Efficiency and risk factors for CMV transmission in seronegative hematopoietic stem cell recipients.

TitleEfficiency and risk factors for CMV transmission in seronegative hematopoietic stem cell recipients.
Publication TypeJournal Article
Year of Publication2012
AuthorsPergam SA, Xie H, Sandhu R, Pollack M, Smith J, Stevens-Ayers T, Ilieva V, Kimball LE, Huang M-, Hayes TS, Corey L, Boeckh MJ
JournalBiology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation// Biol Blood Marrow Transplant
Pagination1391 - 400
Date Published2012//
ISBN Number1523-6536
Other Numbers9600628, cua
Keywords*Antibodies, Viral/im [Immunology], *Bone Marrow Transplantation/ae [Adverse Effects], *Cytomegalovirus Infections/tm [Transmission], *Cytomegalovirus/im [Immunology], *Hematopoietic Stem Cell Transplantation/ae [Adverse Effects], Adult, Antibodies, Viral/bl [Blood], Cytomegalovirus Infections/bl [Blood], Cytomegalovirus Infections/ep [Epidemiology], Cytomegalovirus Infections/im [Immunology], Female, Humans, Incidence, Male, Middle Aged, Proportional Hazards Models, Retrospective Studies, Risk Factors, Tissue Donors, Transplantation, Homologous, United States/ep [Epidemiology]

Cytomegalovirus (CMV) transmission via stem cells or marrow in CMV donor seropositive/recipient seronegative (D+/R-) hematopoietic cell transplantation (HCT) is surprisingly inefficient, and factors associated with transmission in these high-risk HCT recipients are unknown. In a retrospective cohort of D+/R- HCT recipients, cumulative incidence curve estimates were used to determine posttransplantation rates of CMV and multivariable Cox proportional models to assess risk factors associated with transmission. A total of 447 patients from 1995 to 2007 were eligible for enrollment. Overall, 85 of 447 (19.0%) acquired CMV at a median of 49 days (IQR 41-60) posttransplantation. CMV disease before day 100 occurred in 6 of 447 (1.3%) patients and in 7 of 447 (1.6%) after day 100. The donor graft, specifically the total nucleated cell count (adjusted hazard ratio [HR] 2.7; 95% confidence interval [CI], 1.4-4.7, P = .0002), was the only factor associated with CMV transmission in multivariable analyses. Notably, the source stem cells (marrow versus peripheral blood stem cell [PBSC]), screening method, and graft-versus-host disease (GVHD) were not associated with transmission. Thus, a highly cellular graft was the only identifiable risk factor associated with CMV transmission, suggesting that viral genomic content of the donor graft determines transmission efficiency in D+/R- HCT recipients.Copyright © 2012 American Society for Blood and Marrow Transplantation. Published by Elsevier Inc. All rights reserved.

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