Regimen-related mucosal injury of the gut increased the incidence of CMV disease after allogeneic bone marrow transplantation.
Cytomegalovirus (CMV) infection is 1 of the major causes of morbidity in patients undergoing allogeneic stem cell transplantation (allo-SCT). The incidences of CMV antigenemia and CMV disease in 43 patients who received allogeneic bone marrow transplantation (BMT) using a reduced-intensity conditioning (RIC) regimen, which mainly consisted of fludarabine (Flu), busulfan (Bu), and total body irradiation (TBI), were compared with those in 68 patients who received a myeloablative conditioning (MAC) regimen, and risk factors for CMV antigenemia and CMV disease were identified. Before engraftment, grade 3-4 mucosal injury because of the conditioning regimen was significantly decreased in RIC patients (stomatitis: P = .02; diarrhea: P < .01). Rate of engraftment, incidences of acute graft-versus-host disease (aGVHD), and rate of corticosteroid administration were not different in RIC patients and MAC patients. Although the incidences of CMV antigenemia were not significantly different in RIC patients and MAC patients (64.1% versus 57.8%, log rank, P = .59), the incidence of CMV disease was significantly decreased in RIC patients (5.4% versus 20.3%, log rank, P = .04). CMV seropositivity in the patients (P < .01) and corticosteroid administration (P < .01) were revealed by multivariate analysis to be significant risk factors for CMV antigenemia. Grade II-IV aGVHD (P = .02) and grade 3-4 diarrhea before engraftment (P = .04) were revealed to be risk factors for CMV disease. The present study is the first study to show that severe diarrhea before engraftment is a significant risk factor for CMV disease. In summary, risk of CMV disease was significantly decreased in patients without severe mucosal injury of the gut because of the conditioning regimen before engraftment.
Shigematsu
Akio
A
Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan. shigema@med.hokudai.ac.jp
Yasumoto
Atsushi
A
Yamamoto
Satoshi
S
Sugita
Junichi
J
Kondo
Takeshi
T
Onozawa
Masahiro
M
Kahata
Kaoru
K
Endo
Tomoyuki
T
Ota
Shuichi
S
Sato
Norihiro
N
Takahata
Mutsumi
M
Okada
Kohei
K
Tanaka
Junji
J
Hashino
Satoshi
S
Nishio
Mitsufumi
M
Koike
Takao
T
Asaka
Masahiro
M
Imamura
Masahiro
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000956:Antigens, Viral / Q000097:blood; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002066:Busulfan / Q000008:administration & dosage / Q000009:adverse effects; D003586:Cytomegalovirus Infections / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control / Q000635:transmission; D004198:Disease Susceptibility; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D015994:Incidence; D007413:Intestinal Mucosa / Q000187:drug effects / Q000473:pathology* / Q000528:radiation effects; D007564:Japan; D008297:Male; D008875:Middle Aged; D019653:Myeloablative Agonists / Q000009:adverse effects*; D011183:Postoperative Complications / Q000097:blood / Q000453:epidemiology / Q000209:etiology* / Q000517:prevention & control; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D019172:Transplantation Conditioning / Q000009:adverse effects*; D014184:Transplantation, Homologous / Q000009:adverse effects; D014740:Vidarabine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives; D014916:Whole-Body Irradiation / Q000009:adverse effects*; D055815:Young Adult
D000890:Anti-Infective Agents; D000956:Antigens, Viral; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine