title: Transmission of cytomegalovirus (CMV) infection by leukoreduced blood products not tested for CMV antibodies: a single-center prospective study in high-risk patients undergoing allogeneic hematopoietic stem cell transplantation (CME).
abstract: BACKGROUND
  Measures to prevent transfusion-transmitted cytomegalovirus (TT-CMV) infection after hematopoietic stem cell transplantation (HSCT) include transfusion of CMV antibody-negative blood units and/or transfusion of leukoreduced cellular blood products. We assessed the incidence of TT-CMV in CMV-seronegative patients receiving CMV-seronegative HSC transplants, who were transfused with leukoreduced cellular blood products not tested for anti-CMV.
  
  
  METHODS
  In a prospective observational study between 1999 and 2009, all HSCT patients received leukoreduced cellular blood products not tested for anti-CMV. Patients were screened for CMV serostatus and CMV-negative recipients of CMV-negative transplants were systematically monitored for TT-CMV clinically and by CMV nucleic acid testing. Anti-CMV antibodies (immunoglobulin [Ig]G and IgM) were assessed after three time intervals (Interval 1, study inclusion to Day +30 after HSCT; Interval 2, Day +30-Day +100; Interval 3, after Day +100).
  
  
  RESULTS
  Among 142 patients treated with allogeneic HSCT, 23 CMV-negative donor-patient pairs were identified. These 23 patients received 1847 blood products from 3180 donors. All patients remained negative for CMV DNA and none developed CMV-associated clinical complications. This results in a risk for TT-CMV per donor exposure of 0% (95% confidence interval, 0.0%-0.12%). However, 17 of 23 patients seroconverted for anti-CMV IgG, but none for anti-CMV IgM. CMV IgG seroconverters received significantly more transfusions per week than nonconverters.
  
  
  CONCLUSIONS
  The risk of TT-CMV is low in high-risk CMV(neg/neg)  HSCT patients transfused with leukoreduced blood products not tested for anti-CMV. The cause of anti-CMV IgG seroconversion is most likely passive antibody transmission by blood products.
authors.affiliation: Institut für Immunologie und Transfusionsmedizin, Ernst-Moritz-Arndt-Universität, Greifswald, Germany.
authors.forename: Thomas
authors.initials: T
authors.lastname: Thiele
authors.forename: William
authors.initials: W
authors.lastname: Krüger
authors.forename: Kathrin
authors.initials: K
authors.lastname: Zimmermann
authors.forename: Till
authors.initials: T
authors.lastname: Ittermann
authors.forename: Antje
authors.initials: A
authors.lastname: Wessel
authors.forename: Ivo
authors.initials: I
authors.lastname: Steinmetz
authors.forename: Gottfried
authors.initials: G
authors.lastname: Dölken
authors.forename: Andreas
authors.initials: A
authors.lastname: Greinacher
mesh_terms: D000914:Antibodies, Viral / Q000097:blood*; D016913:Blood Component Transfusion; D003587:Cytomegalovirus; D003586:Cytomegalovirus Infections / Q000097:blood / Q000517:prevention & control / Q000635:transmission; D004279:DNA, Viral / Q000097:blood; D046148:Donor Selection / Q000379:methods; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007074:Immunoglobulin G / Q000097:blood*; D007075:Immunoglobulin M / Q000097:blood*; D007937:Leukapheresis; D008297:Male; D011446:Prospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral; D007074:Immunoglobulin G; D007075:Immunoglobulin M