Incidence and outcome of cytomegalovirus infections following nonmyeloablative compared with myeloablative allogeneic stem cell transplantation, a matched control study

被引:187
作者
Junghanss, C
Boeckh, M
Carter, RA
Sandmaier, BM
Maris, MB
Maloney, DG
Chauncey, T
McSweeney, PA
Little, MT
Corey, L
Storb, R
机构
[1] Fred Hutchinson Canc Res Ctr, Seattle, WA 98109 USA
[2] Vet Affairs Med Ctr, Seattle, WA 98108 USA
[3] Univ Washington, Seattle, WA 98195 USA
关键词
D O I
10.1182/blood.V99.6.1978
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Nonmyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) is increasingly being explored as therapy in patients who are not eligible for conventional myeloablative HSCT. Whether these transplants are associated with reduced risk of transplantation-related infections is unknown. We analyzed the incidence of posttransplantation cytomegalovirus (CMV) infections in 56 consecutive mycophenolate mofetil (MMF) patients with hematologic malignancies who underwent nonmyeloablative HSCT (TBI, 2Gy, day 0; MMF/cyclosporine after transplantation). In addition, 18 of 56 patients received 30 mg/m(2)/d fludarabine on days -4 to -2. Most donors were HLA matched and related (93%). Each case patient was matched to 2 controls who were treated by conventional HSCT during the same time period (January 1997 through April 2000). Matching criteria included CMV risk group, HSC source, donor type, age, and underlying diseases. No CMV disease occurred in the low (donor and recipient serologically negative) and intermediate (donor serologically positive and recipient negative) CMV risk groups during the first 100 days. Among cases at high risk for CMV (seropositive recipients), trends to less CMV antigenemia (P = .11), viremia (P = .16), and disease (P = .08) compared with controls were observed; all severe manifestations combined (CMV viremia and disease) were significantly reduced among cases (P = .01). However, by day 365, the overall incidence of CMV disease became similar in both groups. The onset of CMV disease was significantly delayed among case patients compared with controls (median, 130 days versus 52 days; P = .02). It was concluded that CMV disease was significantly delayed in nonmyeloablative cases, but that the overall 1-year incidence was similar to myeloablative HSCT patients. Therefore, nonmyeloablative HSCT patients should receive CMV surveillance beyond day 100 and pre-emptive ganciclovir treatment similar to that of myeloablative HSCT patients.
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页码:1978 / 1985
页数:8
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