Cytomegalovirus (CMV) is a major cause of mortality and morbidity in hematopoietic stem cell transplantation (HSCT). Transfer of CMV-specific T-cells from the donor is important for the control of CMV replication after HSCT. In this study, we compared incidence and kinetics of CMV infection and CMV disease between T-cell depleted (TCD) and unmodified (CONV) HSCT.
Methods: The cohort consisted of 714 adult HSCT recipients of bone marrow or peripheral blood stem cell allografts from September 1999 to March 2010 at Memorial Sloan-Kettering Cancer Center. Patients were followed until July 2012. TCD recipients did not receive any additional prophylactic medicinal immunosuppression for graft-vs-host disease (GvHD). CMV infection was monitored by PP65 antigenemia assay (CMV Ag) if recipient or donor were CMV seropositive and the information was prospectively stored in a computerized database. Prior to 2007, recipients of mismatched or unrelated allografts were eligible for CMV prophylaxis if recipient or donor were CMV seropositive. Anti-CMV agents were given to patients who had >= 2 cells per slide (cps) on 1 occasion or 1 cps on >= 2 consecutive occasions. Relapse, second transplant, death, and study termination (April, 2012) were considered as competing risk for CMV reactivation.
RESULTS: Four hundred and three (56.5%) patients received TCD grafts and 311 (43.6%) received unmodified grafts (CONV). Recipient CMV seropositivity was 48.3% in TCD and 50.8% in CONV (p=0.5219). There are 221 (54.8%) TCD and 140 (45.0%) CONV patients received allograft from mismatched or unrelated donors (p=0.0092). Sixty-four (15.9%) TCD and 45 (14.5%) CONV patients received CMV prophylaxis (p=0.6031). CMV infections occurred in 135 (33.5%) TCD and 86 (27.7%) CONV patients. Two hundred and five (92.8%) of the 221 infections developed by day +100 post-transplant. CMV infections requiring antiviral treatment occurred in 111 (27.5%) TCD and 64 (20.6%) CONV patients (p=0.0319). Days from HSCT to first CMV infection were median 31 in TCD and 41.5 in CONV (p<0.0001). Maximum cps were median 5 (range 1 to 100) cps in TCD and 3 (1 to 100) cps in CONV (p=0.0159). Duration of reactivation was median 11 days in TCD and 8 days in CONV patients (p=0.0042). CMV disease was diagnosed in 4% in TCD patients and 2.3% in CONV patients (p=0.197).
CONCLUSION: 1) Rates of CMV infection were similar in TCD and CONV allogeneic HSCT; 2) In contrast, the kinetics of CMV replication were different between the 2 groups: In TCD, CMV infection occurred earlier, with higher peak level, and longer duration of viremia 3) Rates of CMV disease were low and similar between TCD and CONV (4% and 2.3% respectively) Our data suggests that preemptive treatment based on antigenemia is similarly effective for prevention of CMV disease in TCD and CONV allografts.
See more of: BMT Tandem "Scientific" Meeting