Effect of cytomegalovirus infection on 1-year mortality rates among recipients of allogeneic bone marrow transplants.
The effect of cytomegalovirus (CMV) infection on 1-year mortality rates among allogeneic bone marrow transplant recipients who are receiving a standard protocol as prophylaxis for CMV infection is unclear. We determined the risk factors for death within 1 year among 103 bone marrow transplant recipients by performing a multivariate analysis. The results of donor and recipient CMV serologies did not predict 1-year mortality, although there was a trend towards higher mortality among CMV-seropositive recipients who received marrow from seronegative donors (P = .077). Multivariate analysis revealed that the factors independently associated with 1-year mortality were the development of CMV antigenemia (relative risk [RR] = 2.74; confidence interval [CI] = 1.28-5.86), bone marrow transplantation (BMT) from unrelated donors (RR = 3.20; CI = 1.30-7.92), and severe acute graft-versus-host disease (RR = 3.50; CI = 1.50-8.17). Although significant on univariate analysis, advanced underlying disease before BMT and the development of active CMV disease after BMT were not independent risk factors. In conclusion, the development of CMV antigenemia after BMT was associated with increased 1-year mortality, while the development of active CMV disease was not. Reactivation of CMV infection may represent a marker of poor immune reconstitution or may contribute to further immunosuppression after BMT.
Humar
A
A
Department of Microbiology, Mount Sinai Hospital, Toronto, Ontario, Canada.
Wood
S
S
Lipton
J
J
Messner
H
H
Meharchand
J
J
McGeer
A
A
MacDonald
K
K
Mazzulli
T
T
D000293:Adolescent; D000328:Adult; D016026:Bone Marrow Transplantation / Q000009:adverse effects / Q000401:mortality*; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality* / Q000821:virology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors