Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience
Por:
Pinana, JL, Martino, R, Barba, P, Margall, N, Roig, MC, Valcarcel, D, Sierra, J, Rabella, N
Publicada:
1 mar 2010
Resumen:
The aim of this study was to analyse the incidence and risk factors for cytomegalovirus infection (CMV-I) and disease (CMV-D) after a reduced intensity conditioning allogeneic hematopoietic stem cell transplantation (alloHSCT-RIC). We included 186 consecutive alloHSCT-RIC adult patients at risk for CMV reactivation (patient and/or donor CMV seropositivity). Conditioning regimen was based on fludarabine plus an alkylating agent. For guiding pre-emptive anti-CMV therapy, Pp65 Antigenemia (pp65Ag) (n=116) or quantitative polymerase chain reaction (quantPCR) (n=70) were used. The 2-year incidence of CMV-I and/or CMV-D was 36% (11% for CMV-D). Of note, 12/14 (86%) episodes of CMV-D in the pp65Ag group had lung involvement compared with only 3/15 (20%) in the quantPCR group (P=0.01). Importantly, the number of patients who developed CMV pneumonia with prior negative screening tests was unusually high (67% overall). Multivariate analysis of risk factors for CMV-D identified two risk factors: (i) steroid therapy for moderate-to-severe graft-vs-host disease (GVHD) (hazard ratio 4.7, P=0.02); and (ii) alternative donors (non-HLA-identical siblings) [hazard ratio 2.7, P=0.002]. Our findings suggest that CMV is still a major concern in alloHSCT-RIC. Variables associated with poor anti-CMV T-cell recovery (that is, GVHD and donor type) are helpful in identifying patients at higher risk for CMV-D in the alloHSCT-RIC setting.
Filiaciones:
Pinana, JL:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Div Clin Hematol, Barcelona 08021, Spain
Martino, R:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Div Clin Hematol, Barcelona 08021, Spain
Barba, P:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Div Clin Hematol, Barcelona 08021, Spain
Margall, N:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Microbiol, Barcelona 08021, Spain
Roig, MC:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Microbiol, Barcelona 08021, Spain
Valcarcel, D:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Div Clin Hematol, Barcelona 08021, Spain
Sierra, J:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Div Clin Hematol, Barcelona 08021, Spain
Rabella, N:
Univ Autonoma Barcelona, Hosp Santa Creu & St Pau, Dept Microbiol, Barcelona 08021, Spain
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