Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan.
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.
Tomonari
Akira
A
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan. atomonar@ims.u-tokyo.ac.jp
Iseki
Tohru
T
Ooi
Jun
J
Takahashi
Satoshi
S
Shindo
Motohiro
M
Ishii
Koji
K
Nagamura
Fumitaka
F
Uchimaru
Kaoru
K
Tani
Kenzaburo
K
Tojo
Arinobu
A
Asano
Shigetaka
S
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
D000956:Antigens, Viral; D000998:Antiviral Agents; D015774:Ganciclovir