title: Incidence, nature and mortality of cytomegalovirus infection after double-unit cord blood transplant.
abstract: Cord blood transplant (CBT) extends allograft access but is associated with a significant risk for cytomegalovirus (CMV) infection. We analyzed CMV infection in 157 CBT recipients transplanted for hematological malignancies. As compared with antigenemia testing, routine polymerase chain reaction (PCR) monitoring was associated with increased and earlier CMV infection detection (1-year incidence if seropositive 67% [median onset 41 days] vs. 100% at an earlier 33-day median [p < 0.001]) and decreased gastrointestinal disease. One-year CMV-related transplant-related mortality was 11% in CMV+ patients with 7/9 deaths associated with initial infection. Disease-free survival was lower in seropositive compared with seronegative patients (1-year: 55% vs. 73%, p = 0.02). However, in multivariate analysis adjusting for age, treatment failure risk in CMV+ patients was not significant (hazard ratio 1.52, p = 0.11). CMV infection is a major challenge in seropositive CBT recipients. While PCR surveillance permits early detection of viremia, new prophylaxis and therapeutic strategies are needed.
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center , New York, NY , USA.
authors.forename: Parastoo B
authors.initials: PB
authors.lastname: Dahi
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Perales
authors.forename: Sean M
authors.initials: SM
authors.lastname: Devlin
authors.forename: Amanda
authors.initials: A
authors.lastname: Olson
authors.forename: Marissa
authors.initials: M
authors.lastname: Lubin
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Gonzales
authors.forename: Andromachi
authors.initials: A
authors.lastname: Scaradavou
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Kernan
authors.forename: Richard J
authors.initials: RJ
authors.lastname: O'Reilly
authors.forename: Sergio
authors.initials: S
authors.lastname: Giralt
authors.forename: Ann
authors.initials: A
authors.lastname: Jakubowski
authors.forename: Guenther
authors.initials: G
authors.lastname: Koehne
authors.forename: Esperanza B
authors.initials: EB
authors.lastname: Papadopoulos
authors.forename: Doris M
authors.initials: DM
authors.lastname: Ponce
authors.forename: Craig
authors.initials: C
authors.lastname: Sauter
authors.forename: Genovefa
authors.initials: G
authors.lastname: Papanicolaou
authors.forename: Juliet N
authors.initials: JN
authors.lastname: Barker
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification* / Q000502:physiology; D003586:Cytomegalovirus Infections / Q000453:epidemiology / Q000209:etiology* / Q000821:virology; D004279:DNA, Viral / Q000235:genetics; D018572:Disease-Free Survival; D005767:Gastrointestinal Diseases / Q000209:etiology / Q000821:virology; D019337:Hematologic Neoplasms / Q000628:therapy*; D006801:Humans; D015994:Incidence; D007223:Infant; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D011014:Pneumonia / Q000209:etiology / Q000821:virology; D016016:Proportional Hazards Models; D014766:Viremia / Q000097:blood / Q000821:virology; D055815:Young Adult
chemical_list: D004279:DNA, Viral
keywords: Allogeneic transplant; cord blood; cytomegalovirus; transplant-related mortality