title: Clinical features of late cytomegalovirus infection after hematopoietic stem cell transplantation.
abstract: Late cytomegalovirus (CMV) disease beyond day 100 after hematopoietic stem cell transplantation (HSCT) has become an increasing problem after the introduction of preemptive ganciclovir (GCV) administration. To clarify the risk factors and outcome for late CMV reactivation and disease, we retrospectively analyzed the records of 101 Japanese adult patients who underwent allogeneic HSCT between 1998 and 2005 at our hospital. Fifty-one developed late positive CMV antigenemia, with a cumulative incidence of 53%. Recipient CMV seropositivity, the use of alemtuzumab, chronic GVHD, and high-dose steroids were significantly associated with late positive antigenemia. Eight patients developed late CMV disease, with a cumulative incidence of 8%, including retinitis and gastrointestinal disease. None progressed to a fatal disease. The use of alemtuzumab was identified as an independent significant risk factor for late CMV disease, although it was not associated with increased non-relapse mortality. Among the 51 patients with late positive antigenemia, 28 had consistently less than three positive cells, 25 of whom showed negative conversion without antiviral agents. In conclusion, late CMV antigenemia appeared to develop frequently, especially in patients with profound immune suppression; however, a fatal outcome could be prevented by optimal preemptive therapy. Low-level antigenemia may not require antiviral treatments.
authors.affiliation: Department of Hematology & Oncology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Tokyo, 113-8655, Japan.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Asano-Mori
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Kanda
authors.forename: Kumi
authors.initials: K
authors.lastname: Oshima
authors.forename: Shinichi
authors.initials: S
authors.lastname: Kako
authors.forename: Akihito
authors.initials: A
authors.lastname: Shinohara
authors.forename: Hideki
authors.initials: H
authors.lastname: Nakasone
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sato
authors.forename: Takuro
authors.initials: T
authors.lastname: Watanabe
authors.forename: Noriko
authors.initials: N
authors.lastname: Hosoya
authors.forename: Koji
authors.initials: K
authors.lastname: Izutsu
authors.forename: Takashi
authors.initials: T
authors.lastname: Asai
authors.forename: Akira
authors.initials: A
authors.lastname: Hangaishi
authors.forename: Toru
authors.initials: T
authors.lastname: Motokura
authors.forename: Shigeru
authors.initials: S
authors.lastname: Chiba
authors.forename: Mineo
authors.initials: M
authors.lastname: Kurokawa
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000328:Adult; D000368:Aged; D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000009:adverse effects; D000998:Antiviral Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000517:prevention & control; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000305:Adrenal Cortex Hormones; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D000970:Antineoplastic Agents; D000998:Antiviral Agents; D007166:Immunosuppressive Agents; D000074323:Alemtuzumab