title: Transfusion-transmitted cytomegalovirus infection after receipt of leukoreduced blood products.
abstract: Leukoreduced blood products are reportedly comparable to cytomegalovirus (CMV)-seronegative products for the prevention of transfusion-transmitted CMV (TT-CMV) infection after stem cell (SC) transplantation. To determine if the incidence of TT-CMV was affected by the increasing use of leukoreduced blood products, we followed a prospective cohort of 807 CMV-seronegative SC transplant (SCT) recipients who underwent weekly surveillance using the pp65 antigenemia assay. The incidence of TT-CMV for 2 time periods was recorded: Period 1 (5/94-11/96), when only CMV-seronegative and/or filtered blood products were provided, and period 2 (12/96-2/00), when leukocyte-reduced platelets obtained by apheresis without filtration were also used. The incidence of TT-CMV was higher during period 2 (18/447, 4%) than period 1 (6/360, 1.7%) (P <.05); this was correlated with higher utilization of both filtered and apheresed products from CMV-positive donors in period 2. Multivariable analysis identified filtered red blood cell (RBC) units (but not apheresis platelet products) from CMV-positive donors as the primary predictor of TT-CMV: each additional filtered RBC unit was associated with a 32% increase in the odds for TT-CMV (95% confidence interval [CI]: 8%-61%, P =.006). Pre-emptive therapy with ganciclovir after detection of antigenemia prevented all but one case of CMV disease prior to day 100. CMV-seronegative products may thus be superior to leukoreduced products (particularly filtered RBCs) for the prevention of TT-CMV. In an era of "universal leukoreduction," the abandonment of CMV-seronegative inventories appears premature, particularly among populations at high risk of CMV disease that do not receive active surveillance.
authors.affiliation: Program in Infectious Diseases and Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA. gnichols@fhcrc.org
authors.forename: W Garrett
authors.initials: WG
authors.lastname: Nichols
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Price
authors.forename: Ted
authors.initials: T
authors.lastname: Gooley
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Michael
authors.initials: M
authors.lastname: Boeckh
mesh_terms: D016913:Blood Component Transfusion / Q000009:adverse effects*; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000635:transmission*; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D015999:Multivariate Analysis; D033581:Stem Cell Transplantation / Q000009:adverse effects; D013997:Time Factors; D014184:Transplantation, Homologous