title: Efficiency and risk factors for CMV transmission in seronegative hematopoietic stem cell recipients.
abstract: Cytomegalovirus (CMV) transmission via stem cells or marrow in CMV donor seropositive/recipient seronegative (D+/R-) hematopoietic cell transplantation (HCT) is surprisingly inefficient, and factors associated with transmission in these high-risk HCT recipients are unknown. In a retrospective cohort of D+/R- HCT recipients, cumulative incidence curve estimates were used to determine posttransplantation rates of CMV and multivariable Cox proportional models to assess risk factors associated with transmission. A total of 447 patients from 1995 to 2007 were eligible for enrollment. Overall, 85 of 447 (19.0%) acquired CMV at a median of 49 days (IQR 41-60) posttransplantation. CMV disease before day 100 occurred in 6 of 447 (1.3%) patients and in 7 of 447 (1.6%) after day 100. The donor graft, specifically the total nucleated cell count (adjusted hazard ratio [HR] 2.7; 95% confidence interval [CI], 1.4-4.7, P = .0002), was the only factor associated with CMV transmission in multivariable analyses. Notably, the source stem cells (marrow versus peripheral blood stem cell [PBSC]), screening method, and graft-versus-host disease (GVHD) were not associated with transmission. Thus, a highly cellular graft was the only identifiable risk factor associated with CMV transmission, suggesting that viral genomic content of the donor graft determines transmission efficiency in D+/R- HCT recipients.
authors.affiliation: Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, Washington 98109, USA. spergam@fhcrc.org
authors.forename: Steven A
authors.initials: SA
authors.lastname: Pergam
authors.forename: Hu
authors.initials: H
authors.lastname: Xie
authors.forename: Ravinder
authors.initials: R
authors.lastname: Sandhu
authors.forename: Margaret
authors.initials: M
authors.lastname: Pollack
authors.forename: Jeremy
authors.initials: J
authors.lastname: Smith
authors.forename: Terry
authors.initials: T
authors.lastname: Stevens-Ayers
authors.forename: Valeria
authors.initials: V
authors.lastname: Ilieva
authors.forename: Louise E
authors.initials: LE
authors.lastname: Kimball
authors.forename: Meei-Li
authors.initials: ML
authors.lastname: Huang
authors.forename: Tracy S
authors.initials: TS
authors.lastname: Hayes
authors.forename: Lawrence
authors.initials: L
authors.lastname: Corey
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Boeckh
mesh_terms: D000328:Adult; D000914:Antibodies, Viral / Q000097:blood / Q000276:immunology*; D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000097:blood / Q000453:epidemiology / Q000276:immunology / Q000635:transmission*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D014019:Tissue Donors; D014184:Transplantation, Homologous; D014481:United States / Q000453:epidemiology
chemical_list: D000914:Antibodies, Viral