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Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience.
Bone Marrow Transplant. 2010 Mar; 45(3):534-42.BM

Abstract

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.

Authors+Show Affiliations

Division of Clinical Hematology, Hospital de la Santa Creu i Sant Pau, Universitat Autónoma de, Barcelona, Barcelona, Spain. jpinana@santpau.catNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Clinical Trial
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19668235

Citation

Piñana, J L., et al. "Cytomegalovirus Infection and Disease After Reduced Intensity Conditioning Allogeneic Stem Cell Transplantation: Single-centre Experience." Bone Marrow Transplantation, vol. 45, no. 3, 2010, pp. 534-42.
Piñana JL, Martino R, Barba P, et al. Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience. Bone Marrow Transplant. 2010;45(3):534-42.
Piñana, J. L., Martino, R., Barba, P., Margall, N., Roig, M. C., Valcárcel, D., Sierra, J., & Rabella, N. (2010). Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience. Bone Marrow Transplantation, 45(3), 534-42. https://doi.org/10.1038/bmt.2009.180
Piñana JL, et al. Cytomegalovirus Infection and Disease After Reduced Intensity Conditioning Allogeneic Stem Cell Transplantation: Single-centre Experience. Bone Marrow Transplant. 2010;45(3):534-42. PubMed PMID: 19668235.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience. AU - Piñana,J L, AU - Martino,R, AU - Barba,P, AU - Margall,N, AU - Roig,M C, AU - Valcárcel,D, AU - Sierra,J, AU - Rabella,N, Y1 - 2009/08/10/ PY - 2009/8/12/entrez PY - 2009/8/12/pubmed PY - 2010/6/4/medline SP - 534 EP - 42 JF - Bone marrow transplantation JO - Bone Marrow Transplant VL - 45 IS - 3 N2 - 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. SN - 1476-5365 UR - https://www.unboundmedicine.com/medline/citation/19668235/Cytomegalovirus_infection_and_disease_after_reduced_intensity_conditioning_allogeneic_stem_cell_transplantation:_single_centre_experience_ L2 - https://doi.org/10.1038/bmt.2009.180 DB - PRIME DP - Unbound Medicine ER -