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. 2018 Oct;34(4):636-642.
doi: 10.1007/s12288-018-0960-y. Epub 2018 Apr 16.

A Low Incidence of Cytomegalo Virus Infection Following Allogeneic Hematopoietic Stem Cell Transplantation Despite a High Seroprevalence

Anup J Devasia  1 , Shoba Mammen  2 , Anu Korula  1 , Aby Abraham  1 , N A Fouzia  1 , Kavitha M Lakshmi  1 , Asha Mary Abraham  2 , Alok Srivastava  1 , Vikram Mathews  1 , Biju George  1
Affiliations

A Low Incidence of Cytomegalo Virus Infection Following Allogeneic Hematopoietic Stem Cell Transplantation Despite a High Seroprevalence

Anup J Devasia et al. Indian J Hematol Blood Transfus. 2018 Oct.

Abstract

Cytomegalovirus (CMV) infection remains an important cause of morbidity and mortality following allogeneic stem cell transplantation (SCT). We wanted to study if the high sero-prevalence seen in our population translated into a high incidence of CMV infection following SCT. This is a retrospective analysis of patients who underwent allogeneic SCT between January 2008 and December 2012 at our centre. 475 patients underwent allogeneic SCT for malignant (46.5%) and non-malignant (53.5%) haematological disorders. 463 (97.4%) SCT recipients and 403 (84.8%) SCT donors were IgG seropositive for CMV. CMV reactivation within 100 days post SCT was seen in 174 (36.6%) at a median of 41 days (range 10-100) post SCT. Ganciclovir was used in 166 patients (95.4%) for a mean duration of 16 days (range 5-32). 157 patients (90%) responded to therapy. Sixty-six patients (42.3%) had secondary reactivation of the virus. Use of a male donor (p = 0.000), donor and recipient age > 15 (p = 0.005 and 0.000), unrelated donor (p = 0.000), degree of HLA mismatch (p = 0.000), occurrence of acute GVHD (p = 0.000) and steroid refractory acute GVHD (p = 0.026) were identified as risk factors for CMV reactivation while early neutrophil recovery (< 15 days) was found to be protective (p = 0.004). On multivariate analysis, male donor (p = 0.042), degree of HLA mismatch (p = 0.006), the occurrence of acute GVHD (p = 0.000) and steroid refractory acute GVHD (p = 0.031) continued to remain significant. 5-year overall survival was significantly better in patients without CMV reactivation compared to those who developed reactivation of CMV (68.9 ± 3.7 vs 58.2 ± 4.9% p = 0.004). The incidence of CMV infection does not seem to be higher despite a high sero-prevalence of CMV. However, patients who developed CMV infection post SCT had inferior outcomes.

Keywords: Cytomegalo virus; Seroprevalence; Stem cell transplantation.

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Conflict of interest statement

The authors have no conflicts of interest to declare.Informed consent was obtained from all human participants involved in this study. All procedures performed in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Figures

Fig. 1
Fig. 1
Comparison of overall survival between patients who had CMV reactivation versus those who did not have CMV reactivation. CMV reactivation had an adverse effect on overall survival (OS) with a significantly lower 5 years OS of 58.2 ± 4.9% in patients with CMV reactivation compared to 5 years OS of 68.9 ± 3.7% (p = 0.004) without CMV reactivation
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