title: Cytomegalovirus Infection after CD34(+)-Selected Hematopoietic Cell Transplantation.
abstract: The effectiveness of preemptive treatment (PET) for cytomegalovirus (CMV) in recipients of ex vivo T cell-depleted (TCD) hematopoietic cell transplantation (HCT) by CD34(+) selection is not well defined. We analyzed 213 adults who received TCD-HCT at our institution from June 2010 through May 2014. Patients were monitored by a CMV quantitative PCR assay if recipient (R) or donor (D) were CMV seropositive. CMV viremia occurred early (median, 27 days after HCT) in 91 of 213 (42.7%) patients for a 180-day cumulative incidence of 84.5%, 61.8%, and 0 for R+/D+, R+/D-, and R-/D+ patients, respectively. CMV disease occurred in 5% of patients. In Cox regression analysis, R+/D+ status was associated with increased risk for CMV viremia compared with R+/D- (hazard ratio [HR], 1.79, 95% confidence interval [CI], 1.16 to 2.76, P = .01), whereas matched unrelated donor allograft was associated with decreased risk (HR, .62; 95% CI, .39 to .97, P = .04). Of 91 patients with CMV viremia, 52 (57%) had persistent viremia (>28 days duration). Time lag from detection of CMV viremia to PET was associated with incremental risk for persistent viremia (HR, 1.09; 95% CI, 1.01 to 1.18; P = .03). Overall, 166 of 213 (77.9%) patients were alive 1 year after HCT, with no difference between patients with and without CMV viremia or among the different CMV serostatus pairs (P = not significant). CMV viremia occurred in 70% of R + TCD-HCT. Delay in PET initiation was associated with persistent viremia. With PET, CMV R/D serostatus did not adversely impact survival in TCD-HCT on 1-year survival in the present cohort.
authors.affiliation: Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Yao-Ting
authors.initials: YT
authors.lastname: Huang
authors.affiliation: Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York.
authors.forename: Dionysios
authors.initials: D
authors.lastname: Neofytos
authors.affiliation: Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Julia
authors.initials: J
authors.lastname: Foldi
authors.affiliation: Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Seong Jin
authors.initials: SJ
authors.lastname: Kim
authors.affiliation: Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Molly
authors.initials: M
authors.lastname: Maloy
authors.affiliation: Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Dick
authors.initials: D
authors.lastname: Chung
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Hugo
authors.initials: H
authors.lastname: Castro-Malaspina
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Sergio A
authors.initials: SA
authors.lastname: Giralt
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Papadopoulos
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Miguel-Angel
authors.initials: MA
authors.lastname: Perales
authors.affiliation: Department of Medicine, Weill Cornell Medical College, New York, New York; Adult Bone Marrow Transplantation Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York.
authors.forename: Ann A
authors.initials: AA
authors.lastname: Jakubowski
authors.affiliation: Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York. Electronic address: papanicg@mskcc.org.
authors.forename: Genovefa A
authors.initials: GA
authors.lastname: Papanicolaou
mesh_terms: D000328:Adult; D000368:Aged; D018952:Antigens, CD34 / Q000032:analysis; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D015994:Incidence; D008212:Lymphocyte Depletion / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011292:Premedication / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D013601:T-Lymphocytes; D014019:Tissue Donors; D014766:Viremia; D055815:Young Adult
chemical_list: D018952:Antigens, CD34
keywords: CMV viremia; Cytomegalovirus; Epidemiology; Hematopoietic cell transplantation; T cell depletion