CMV-antigenemia after allogeneic bone marrow transplantation: Correlation of CMV-antigen positive cell numbers with transplant-related mortality

A. Bacigalupo, E. Tedone, A. Isaza, M. Soracco, M. T. Van Lint, A. Sanna, F. Frassoni, D. Occhini, F. Gualandi, T. Lamparelli, O. Figari, F. Benvenuto, M. R. Raffo, A. M. Marmont

Research output: Contribution to journalArticlepeer-review

Abstract

One hundred and thirty-four consecutive patients undergoing HLA-identical BMT were prospectively followed on a weekly basis for the development of CMV antigenemia (CMVAg-emia). End-points of the study were (1) incidence, (2) risk factors, and (3) predictive effect on transplant-related mortality (TRM). Fifty-six patients developed CMVAg-emia between day 8-366 (median 40) with an overall actuarial risk of 43%. The median number of positive cells at diagnosis was 4 (range 1-48) the median maximum number was 6.5 (range 1-435). Positive cells are expressed as number/2.5 x 105 cells. In multivariate analysis, T cell depletion (TCD) (RR 2.9, P = 0.0009) and acute graft-versus-host disease (RR 2.1, P = 0.01) were the two risk factors predictive for CMVAg-emia. The risk of developing CMV-IP was significantly higher in patients with, as compared to patients without, CMVAg-emia (P = 0.0005) and occurred mostly in patients who received TCD marrow (P = 0.0009) despite treatment with gancyclovir or foscarnet at the time of CMVAg-emia. TRM was 24% in patients not developing CMVAg-emia; it was 21 and 47% in patients with positive cells at diagnosis of CMV (P = 0.008), and 12 vs 54% for patients with positive cells during infection (P = 0.0003). Both were predictive of TRM in multivariate analysis (P = 0.04 and P = 0.002). In conclusion, the risk of developing CMVAg-emia post-allo BMT is influenced by the marrow T cell content and by the occurrence of acute GVHD. High numbers of CMV antigen positive cells are associated with considerable transplant-related mortality, and may therefore identify patients eligible for early aggressive therapy.

Original languageEnglish
Pages (from-to)155-161
Number of pages7
JournalBone Marrow Transplantation
Volume16
Issue number1
Publication statusPublished - 1995

Keywords

  • Bone marrow transplant
  • CMV-cytomegalovirus
  • Foscarnet
  • Gancyclovir

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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