title: Risk factors for the development of cytomegalovirus disease after allogeneic stem cell transplantation.
abstract: OBJECTIVE
  Cytomegalovirus (CMV) disease remains an important complication of allogeneic stem cell transplantation (SCT). We studied viral load kinetics and correlated the viral load and other transplant factors with the development of CMV disease.
  
  
  METHODS
  We studied 162 consecutive patients who were CMV seropositive or had CMV seropositive donors. Quantification of CMV DNA was performed by real-time polymerase chain reaction.
  
  
  RESULTS
  CMV DNA detected was detected in 105 of the 162 patients. The mean peak viral loads were similar at first and subsequent reactivations. The serologic status of the donors and recipients prior to SCT significantly influenced the viral load. The cumulative incidence of CMV disease was 1.8% at 100 days and 6.3% at 365 days after SCT. The peak viral load were higher in patients who developed CMV disease than in patients without CMV disease (log10 3.5; SE +/- 0.26/200,000 cells vs. log10 2.7; SE +/- 0.09/200,000 cells; p=0.02). However, in multivariate analysis, only acute graft-versus-host disease (GVHD) grade II-IV and a graft from a CMV-negative donor to a CMV-positive patient were significant risk factors for CMV disease. In patients who required more than one course of pre-emptive therapy, acute GVHD and the rate of decrease in viral load during first pre-emptive therapy were significant risk factors for subsequent development of CMV disease.
  
  
  CONCLUSIONS
  A decrease in viral load during pre-emptive therapy is an important factor for later development of CMV disease.
authors.affiliation: Hematology Center, Karolinska University Hospital, SE-14186 Stockholm, Sweden. Per.Ljungman@medhs.ki.se
authors.forename: Per
authors.initials: P
authors.lastname: Ljungman
authors.forename: Lena
authors.initials: L
authors.lastname: Perez-Bercoff
authors.forename: Jerker
authors.initials: J
authors.lastname: Jonsson
authors.forename: Gayane
authors.initials: G
authors.lastname: Avetisyan
authors.forename: Elda
authors.initials: E
authors.lastname: Sparrelid
authors.forename: Johan
authors.initials: J
authors.lastname: Aschan
authors.forename: Lisbeth
authors.initials: L
authors.lastname: Barkholt
authors.forename: Kajsa
authors.initials: K
authors.lastname: Larsson
authors.forename: Jacek
authors.initials: J
authors.lastname: Winiarski
authors.forename: Zhibing
authors.initials: Z
authors.lastname: Yun
authors.forename: Olle
authors.initials: O
authors.lastname: Ringdén
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003586:Cytomegalovirus Infections / Q000209:etiology*; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D009894:Opportunistic Infections; D011292:Premedication; D012307:Risk Factors; D014184:Transplantation, Homologous; D019562:Viral Load