Donor cytomegalovirus status influences the outcome of allogeneic stem cell transplant: a study by the European group for blood and marrow transplantation.
BACKGROUND
The use of a cytomegalovirus (CMV)-seronegative donor for a CMV-seronegative allogeneic hematopoietic stem cell transplant (HSCT) recipient is generally accepted. However, the importance of donor serostatus in CMV-seropositive patients is controversial.


METHODS
A total of 49 542 HSCT patients, 29 349 seropositive and 20 193 seronegative, were identified from the European Group for Blood and Marrow Transplantation database. Cox multivariate models were fitted to estimate the effect of donor CMV serological status on outcome.


RESULTS
Seronegative patients receiving seropositive unrelated-donor grafts had decreased overall survival (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.21; P < .0001) compared with seronegative donors, whereas no difference was seen in patients receiving HLA-matched sibling grafts. Seropositive patients receiving grafts from seropositive unrelated donors had improved overall survival (HR, 0.92; 95% CI, .86-.98; P < .01) compared with seronegative donors, if they had received myeloablative conditioning. This effect was absent when they received reduced-intensity conditioning. No effect was seen in patients grafted from HLA-identical sibling donors. The same association was found if the study was limited to patients receiving transplants from the year 2000 onward.


CONCLUSIONS
We confirm the negative impact on overall survival if a CMV-seropositive unrelated donor is selected for a CMV-seronegative patient. For a CMV-seropositive patient, our data support selecting a CMV-seropositive donor if the patient receives a myeloablative conditioning regimen.
Department of Hematology, Karolinska University Hospital, and Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
Per
P
Ljungman
Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, The Netherlands.
Ronald
R
Brand
Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, The Netherlands.
Jennifer
J
Hoek
Department of Hematology, Hospital de la Princesa, Madrid, Spain.
Rafael
R
de la Camara
Sve d' Hematologie, Hôpital Henri Mondor, Creteil, France.
Catherine
C
Cordonnier
Med. Klinik und Poliklinik II, Universitätsklinikum Würzburg, Germany.
Hermann
H
Einsele
Pediatric Hematology and Oncology, Collegium Medicum UMK, University Hospital, Bydgoszcz, Poland.
Jan
J
Styczynski
Division of Infection and Immunity, University College London, United Kingdom;
Katherine N
KN
Ward
Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy.
Simone
S
Cesaro
D000328:Adult; D003586:Cytomegalovirus Infections / Q000276:immunology*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016019:Survival Analysis; D014019:Tissue Donors; D019172:Transplantation Conditioning; D014184:Transplantation, Homologous / Q000009:adverse effects*; D016896:Treatment Outcome; D055815:Young Adult
CMV; donor; recipient; serological status; stem cell transplant