Efficiency and Risk Factors for CMV Transmission in Seronegative Hematopoietic Stem Cell Recipients

• Published in: Biology of blood and marrow transplantation Vol. 18; no. 9; pp. 1391 - 1400
• Main Authors: Pergam, Steven A, Xie, Hu, Sandhu, Ravinder, Pollack, Margaret, Smith, Jeremy, Stevens-Ayers, Terry, Ilieva, Valeria, Kimball, Louise E, Huang, Meei-Li, Hayes, Tracy S, Corey, Lawrence, Boeckh, Michael J
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2012
• Subjects: Adult; Antibodies, Viral - blood; Antibodies, Viral - immunology; Bone Marrow Transplantation - adverse effects; Cytomegalovirus; Cytomegalovirus - immunology; Cytomegalovirus Infections - blood; Cytomegalovirus Infections - epidemiology; Cytomegalovirus Infections - immunology; Cytomegalovirus Infections - transmission; Donor; Female; Graft; Hematology, Oncology and Palliative Medicine; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Incidence; Male; Middle Aged; Proportional Hazards Models; Retrospective Studies; Risk Factors; Tissue Donors; Transmission; Transplantation, Homologous; United States - epidemiology; United States; Cytomegalovirus; Graft; Donor; Transmission
• ISSN: 1083-8791; 1523-6536
• DOI: 10.1016/j.bbmt.2012.02.008

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.