Donor CMV serologic status and outcome of CMV-seropositive recipients after unrelated donor stem cell transplantation: An EBMT megafile analysis

Per Ljungman, Ronald Brand, Hermann Einsele, Francesco Frassoni, Dietger Niederwieser, Catherine Cordonnier

Research output: Contribution to journalArticle

188 Citations (Scopus)

Abstract

Cytomegalovirus (CMV) has been a major cause of morbidity and mortality after allogeneic stem cell transplantation (SCT). The importance of the recipient's serologic status is paramount. However, the importance of the donor's serologic status in CMV-seropositive recipients is controversial. We analyzed the influence of the donor's CMV status in a large cohort of patients. A total of 7018 patients seropositive for CMV reported to the European Group for Blood and Marrow Transplantation (EBMT) were included; 5910 patients had undergone HLA-identical sibling SCT and 1108 patients had undergone unrelated donor SCT. Univariate and multivariate proportional hazards models were constructed for survival, event-free survival, transplant-related mortality, and relapse incidence. Patients receiving grafts from CMV-seropositive HLA-identical sibling donors had the same survival as patients grafted from seronegative donors (hazard ratio [HR], 1.04; P = .37; 95% confidence interval [CI], 0.95-1.14). However, unrelated donor stem cell (SC) transplant recipients receiving grafts from CMV-seropositive donors had an improved 5-year survival (35% versus 27%; HR = 0.8; P = .006), an improved event-free survival (30% versus 22%; HR = 0.8; P = .01), and a reduced transplant-related mortality (49% versus 62%; HR = 0.7; P <.001). There was no influence on the relapse incidence. The effects of donor CMV status remained in multivariate analyses. The effect of donor status was different among different disease categories. In patients with chronic myelogenous leukemia (CML), T-cell depletion abrogated the beneficial effect of donor status, suggesting that the effect is mediated through transfer of donor immunity. Our data suggest that donor CMV status influences outcome of unrelated SCT. For a CMV-seropositive patient, a seropositive donor might be preferable.

Original languageEnglish
Pages (from-to)4255-4260
Number of pages6
JournalBlood
Volume102
Issue number13
DOIs
Publication statusPublished - Dec 15 2003

Fingerprint

Unrelated Donors
Stem Cell Transplantation
Blood Group Antigens
Stem cells
Cytomegalovirus
Hazards
Transplantation
Bone Marrow
Transplants
Tissue Donors
Grafts
T-cells
Disease-Free Survival
Survival
Mortality
Siblings
Recurrence
Incidence
Leukemia, Myelogenous, Chronic, BCR-ABL Positive
Proportional Hazards Models

ASJC Scopus subject areas

  • Hematology

Cite this

Donor CMV serologic status and outcome of CMV-seropositive recipients after unrelated donor stem cell transplantation : An EBMT megafile analysis. / Ljungman, Per; Brand, Ronald; Einsele, Hermann; Frassoni, Francesco; Niederwieser, Dietger; Cordonnier, Catherine.

In: Blood, Vol. 102, No. 13, 15.12.2003, p. 4255-4260.

Research output: Contribution to journalArticle

Ljungman, Per ; Brand, Ronald ; Einsele, Hermann ; Frassoni, Francesco ; Niederwieser, Dietger ; Cordonnier, Catherine. / Donor CMV serologic status and outcome of CMV-seropositive recipients after unrelated donor stem cell transplantation : An EBMT megafile analysis. In: Blood. 2003 ; Vol. 102, No. 13. pp. 4255-4260.
@article{6f7e3d35077f40ebbfaea6b318e936b3,
title = "Donor CMV serologic status and outcome of CMV-seropositive recipients after unrelated donor stem cell transplantation: An EBMT megafile analysis",
abstract = "Cytomegalovirus (CMV) has been a major cause of morbidity and mortality after allogeneic stem cell transplantation (SCT). The importance of the recipient's serologic status is paramount. However, the importance of the donor's serologic status in CMV-seropositive recipients is controversial. We analyzed the influence of the donor's CMV status in a large cohort of patients. A total of 7018 patients seropositive for CMV reported to the European Group for Blood and Marrow Transplantation (EBMT) were included; 5910 patients had undergone HLA-identical sibling SCT and 1108 patients had undergone unrelated donor SCT. Univariate and multivariate proportional hazards models were constructed for survival, event-free survival, transplant-related mortality, and relapse incidence. Patients receiving grafts from CMV-seropositive HLA-identical sibling donors had the same survival as patients grafted from seronegative donors (hazard ratio [HR], 1.04; P = .37; 95{\%} confidence interval [CI], 0.95-1.14). However, unrelated donor stem cell (SC) transplant recipients receiving grafts from CMV-seropositive donors had an improved 5-year survival (35{\%} versus 27{\%}; HR = 0.8; P = .006), an improved event-free survival (30{\%} versus 22{\%}; HR = 0.8; P = .01), and a reduced transplant-related mortality (49{\%} versus 62{\%}; HR = 0.7; P <.001). There was no influence on the relapse incidence. The effects of donor CMV status remained in multivariate analyses. The effect of donor status was different among different disease categories. In patients with chronic myelogenous leukemia (CML), T-cell depletion abrogated the beneficial effect of donor status, suggesting that the effect is mediated through transfer of donor immunity. Our data suggest that donor CMV status influences outcome of unrelated SCT. For a CMV-seropositive patient, a seropositive donor might be preferable.",
author = "Per Ljungman and Ronald Brand and Hermann Einsele and Francesco Frassoni and Dietger Niederwieser and Catherine Cordonnier",
year = "2003",
month = "12",
day = "15",
doi = "10.1182/blood-2002-10-3263",
language = "English",
volume = "102",
pages = "4255--4260",
journal = "Blood",
issn = "0006-4971",
publisher = "American Society of Hematology",
number = "13",

}

TY - JOUR

T1 - Donor CMV serologic status and outcome of CMV-seropositive recipients after unrelated donor stem cell transplantation

T2 - An EBMT megafile analysis

AU - Ljungman, Per

AU - Brand, Ronald

AU - Einsele, Hermann

AU - Frassoni, Francesco

AU - Niederwieser, Dietger

AU - Cordonnier, Catherine

PY - 2003/12/15

Y1 - 2003/12/15

N2 - Cytomegalovirus (CMV) has been a major cause of morbidity and mortality after allogeneic stem cell transplantation (SCT). The importance of the recipient's serologic status is paramount. However, the importance of the donor's serologic status in CMV-seropositive recipients is controversial. We analyzed the influence of the donor's CMV status in a large cohort of patients. A total of 7018 patients seropositive for CMV reported to the European Group for Blood and Marrow Transplantation (EBMT) were included; 5910 patients had undergone HLA-identical sibling SCT and 1108 patients had undergone unrelated donor SCT. Univariate and multivariate proportional hazards models were constructed for survival, event-free survival, transplant-related mortality, and relapse incidence. Patients receiving grafts from CMV-seropositive HLA-identical sibling donors had the same survival as patients grafted from seronegative donors (hazard ratio [HR], 1.04; P = .37; 95% confidence interval [CI], 0.95-1.14). However, unrelated donor stem cell (SC) transplant recipients receiving grafts from CMV-seropositive donors had an improved 5-year survival (35% versus 27%; HR = 0.8; P = .006), an improved event-free survival (30% versus 22%; HR = 0.8; P = .01), and a reduced transplant-related mortality (49% versus 62%; HR = 0.7; P <.001). There was no influence on the relapse incidence. The effects of donor CMV status remained in multivariate analyses. The effect of donor status was different among different disease categories. In patients with chronic myelogenous leukemia (CML), T-cell depletion abrogated the beneficial effect of donor status, suggesting that the effect is mediated through transfer of donor immunity. Our data suggest that donor CMV status influences outcome of unrelated SCT. For a CMV-seropositive patient, a seropositive donor might be preferable.

AB - Cytomegalovirus (CMV) has been a major cause of morbidity and mortality after allogeneic stem cell transplantation (SCT). The importance of the recipient's serologic status is paramount. However, the importance of the donor's serologic status in CMV-seropositive recipients is controversial. We analyzed the influence of the donor's CMV status in a large cohort of patients. A total of 7018 patients seropositive for CMV reported to the European Group for Blood and Marrow Transplantation (EBMT) were included; 5910 patients had undergone HLA-identical sibling SCT and 1108 patients had undergone unrelated donor SCT. Univariate and multivariate proportional hazards models were constructed for survival, event-free survival, transplant-related mortality, and relapse incidence. Patients receiving grafts from CMV-seropositive HLA-identical sibling donors had the same survival as patients grafted from seronegative donors (hazard ratio [HR], 1.04; P = .37; 95% confidence interval [CI], 0.95-1.14). However, unrelated donor stem cell (SC) transplant recipients receiving grafts from CMV-seropositive donors had an improved 5-year survival (35% versus 27%; HR = 0.8; P = .006), an improved event-free survival (30% versus 22%; HR = 0.8; P = .01), and a reduced transplant-related mortality (49% versus 62%; HR = 0.7; P <.001). There was no influence on the relapse incidence. The effects of donor CMV status remained in multivariate analyses. The effect of donor status was different among different disease categories. In patients with chronic myelogenous leukemia (CML), T-cell depletion abrogated the beneficial effect of donor status, suggesting that the effect is mediated through transfer of donor immunity. Our data suggest that donor CMV status influences outcome of unrelated SCT. For a CMV-seropositive patient, a seropositive donor might be preferable.

UR - http://www.scopus.com/inward/record.url?scp=0344305505&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0344305505&partnerID=8YFLogxK

U2 - 10.1182/blood-2002-10-3263

DO - 10.1182/blood-2002-10-3263

M3 - Article

C2 - 12933590

AN - SCOPUS:0344305505

VL - 102

SP - 4255

EP - 4260

JO - Blood

JF - Blood

SN - 0006-4971

IS - 13

ER -