title: Risk factors for late cytomegalovirus infection after allogeneic stem cell transplantation using HLA-matched sibling donor: donor lymphocyte infusion and previous history of early CMV infection.
abstract: An increased incidence of late cytomegalovirus (CMV) infection has been reported during the last decade since the introduction of ganciclovir (GCV) prophylaxis or GCV pre-emptive therapy. Given that a donor lymphocyte infusion (DLI) can induce more severe GVHD, this may predispose a patient to late CMV infection. In all, 64 patients (median age 36, M/F 38/26) underwent allogeneic stem cell transplantation (SCT) using a matched sibling donor with bone marrow (n=9) or peripheral blood stem cells (n=55). The overall incidence of CMV infection, early and late CMV infection was 46.9 (30/64), 42.2 (27/64), and 16.4% (9/55), respectively. Early CMV infection was treated with GCV pre-emptive therapy that produced a 92.6% success rate. Among the 20 patients who received 35 DLIs, late CMV infection developed in eight (42.1%) of 19 evaluable cases with a median onset at 127 days post transplant. Risk factors for late CMV infection in a logistic regression analysis included DLIs (P=0.001) and a previous history of CMV infection (P=0.006). In conclusion, late CMV infection was strongly associated with DLIs and a previous history of early CMV infection. Accordingly, extended surveillance of CMV antigenemia is recommended for patients receiving DLIs or who have a previous history of CMV infection.
authors.affiliation: Department of Hematology/Oncology, Kyungpook National University Hospital, Daegu 700-721, Korea.
authors.forename: D H
authors.initials: DH
authors.lastname: Kim
authors.forename: J G
authors.initials: JG
authors.lastname: Kim
authors.forename: N Y
authors.initials: NY
authors.lastname: Lee
authors.forename: W J
authors.initials: WJ
authors.lastname: Sung
authors.forename: S K
authors.initials: SK
authors.lastname: Sohn
authors.forename: J S
authors.initials: JS
authors.lastname: Suh
authors.forename: K S
authors.initials: KS
authors.lastname: Lee
authors.forename: K B
authors.initials: KB
authors.lastname: Lee
mesh_terms: D000328:Adult; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use; D006086:Graft vs Host Disease / Q000209:etiology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D006650:Histocompatibility Testing; D006801:Humans; D015994:Incidence; D017710:Lymphocyte Transfusion / Q000009:adverse effects*; D008297:Male; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D035781:Siblings; D013995:Time; D014184:Transplantation, Homologous
chemical_list: D015774:Ganciclovir