title: Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan.
abstract: Cytomegalovirus (CMV) infection in 28 adult patients after cord blood transplantation (CBT) from unrelated donors was compared with that after bone marrow transplantation from HLA (human leucocyte antigen)-matched related (R-BMT) and unrelated (U-BMT) donors. Positive CMV antigenaemia was seen in 19 (79%) of 24 CMV-seropositive patients at a median of 42 d (range 29-85 d) after CBT, but in zero of four CMV-seronegative patients. This did not differ significantly from values observed after R-BMT and U-BMT (66%, P = 0.22, and 60%, P = 0.15 respectively). Based on the antigenaemia results, 16 patients (67%) received pre-emptive ganciclovir therapy from a median of 47 d (range 36-67 d) after CBT. This proportion was higher than that observed after R-BMT (28%, P = 0.0048), but did not differ from that after U-BMT (50%, P = 0.21). In addition, the probability of requiring more than two courses of ganciclovir therapy after CBT (21%) was higher than after R-BMT and U-BMT (0%, P = 0.015 and 0.039 respectively). One patient (5%) developed CMV disease after U-BMT, whereas no patients developed CMV disease after CBT or R-BMT. The CMV serostatus, use of a steroid and HLA disparity affected the probability of requiring ganciclovir therapy after CBT (P = 0.024, 0.032 and 0.017 respectively). These results suggest that recovery of CMV-specific immunity after CBT is delayed when compared with BMT.
authors.affiliation: Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. atomonar@ims.u-tokyo.ac.jp
authors.forename: Akira
authors.initials: A
authors.lastname: Tomonari
authors.forename: Tohru
authors.initials: T
authors.lastname: Iseki
authors.forename: Jun
authors.initials: J
authors.lastname: Ooi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Takahashi
authors.forename: Motohiro
authors.initials: M
authors.lastname: Shindo
authors.forename: Koji
authors.initials: K
authors.lastname: Ishii
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Nagamura
authors.forename: Kaoru
authors.initials: K
authors.lastname: Uchimaru
authors.forename: Kenzaburo
authors.initials: K
authors.lastname: Tani
authors.forename: Arinobu
authors.initials: A
authors.lastname: Tojo
authors.forename: Shigetaka
authors.initials: S
authors.lastname: Asano
mesh_terms: D000328:Adult; D000956:Antigens, Viral / Q000097:blood; D000998:Antiviral Agents / Q000627:therapeutic use; D016026:Bone Marrow Transplantation; D036101:Cord Blood Stem Cell Transplantation; D003587:Cytomegalovirus / Q000276:immunology / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000188:drug therapy / Q000276:immunology*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D019337:Hematologic Neoplasms / Q000601:surgery* / Q000821:virology; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors; D014775:Virus Activation
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D015774:Ganciclovir