Impact of cytomegalovirus (CMV) reactivation after umbilical cord blood transplantation.
This study investigated the impact of pretransplant cytomegalovirus (CMV) serostatus and posttransplant CMV reactivation and disease on umbilical cord blood transplant (UCBT) outcomes. Between 1994 and 2007, 332 patients with hematologic malignancies underwent UCBT and 54% were CMV seropositive. Pretransplant recipient CMV serostatus had no impact on acute or chronic graft-versus-host disease (aGVHD, cGVHD), relapse, disease-free survival (DFS), or overall survival (OS). There was a trend toward greater day 100 treatment-related mortality (TRM) in CMV-seropositive recipients (P=.07). CMV reactivation occurred in 51% (92/180) of patients with no difference in myeloablative (MA) versus reduced-intensity conditioning (RIC) recipients (P=.33). Similarly, reactivation was not influenced by the number of UCB units transplanted, the degree of HLA disparity, the CD34(+) or CD3(+) cell dose, or donor killer cell immunoglobulin-like receptor (KIR) gene haplotype. Rapid lymphocyte recovery was associated with CMV reactivation (P=.02). CMV reactivation was not associated with aGVHD (P=.97) or cGVHD (P=.65), nor did it impact TRM (P=.88), relapse (P=.62), or survival (P=.78). CMV disease occurred in 13.8% of the CMV-seropositive patients, resulting in higher TRM (P=.01) and lower OS (P=.02). Thus, although recipient CMV serostatus and CMV reactivation have little demonstrable impact on UCB transplant outcomes, the development of CMV disease remains a risk, associated with inferior outcomes.
Department of Pediatrics, Division of Blood and Marrow Transplantation, University of Minnesota, Minneapolis, Minnesota 55455, USA.
Jill C
JC
Beck
John E
JE
Wagner
Todd E
TE
DeFor
Claudio G
CG
Brunstein
Mark R
MR
Schleiss
Jo-Anne
JA
Young
Daniel H
DH
Weisdorf
Sarah
S
Cooley
Jeffrey S
JS
Miller
Michael R
MR
Verneris
D000208:Acute Disease; D000375:Aging; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects*; D003587:Cytomegalovirus / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000453:epidemiology* / Q000401:mortality / Q000821:virology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D012008:Recurrence; D012307:Risk Factors; D012698:Serologic Tests; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D014775:Virus Activation