title: Regimen-related mucosal injury of the gut increased the incidence of CMV disease after allogeneic bone marrow transplantation.
abstract: 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.
authors.affiliation: Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan. shigema@med.hokudai.ac.jp
authors.forename: Akio
authors.initials: A
authors.lastname: Shigematsu
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yasumoto
authors.forename: Satoshi
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Junichi
authors.initials: J
authors.lastname: Sugita
authors.forename: Takeshi
authors.initials: T
authors.lastname: Kondo
authors.forename: Masahiro
authors.initials: M
authors.lastname: Onozawa
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kahata
authors.forename: Tomoyuki
authors.initials: T
authors.lastname: Endo
authors.forename: Shuichi
authors.initials: S
authors.lastname: Ota
authors.forename: Norihiro
authors.initials: N
authors.lastname: Sato
authors.forename: Mutsumi
authors.initials: M
authors.lastname: Takahata
authors.forename: Kohei
authors.initials: K
authors.lastname: Okada
authors.forename: Junji
authors.initials: J
authors.lastname: Tanaka
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hashino
authors.forename: Mitsufumi
authors.initials: M
authors.lastname: Nishio
authors.forename: Takao
authors.initials: T
authors.lastname: Koike
authors.forename: Masahiro
authors.initials: M
authors.lastname: Asaka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Imamura
mesh_terms: 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
chemical_list: D000890:Anti-Infective Agents; D000956:Antigens, Viral; D007166:Immunosuppressive Agents; D019653:Myeloablative Agonists; D014740:Vidarabine; D002066:Busulfan; C024352:fludarabine