Characteristics and Outcome of Cytomegalovirus (CMV) Infections in 95 Cord Blood Transplant (CBT) Recipients: The MD Anderson Experience

Background: CMV infection remains an important cause of morbidity & mortality in CBT recipients. The objective of this study was to determine the incidence and to examine the characteristics & outcome of CMV infections in 95 CBT recipients.

Methods: We identified CBT recipients who were cared for at our institution between 2000 & 2007 from the Stem Cell Transplant databases. Data on demographics, underlying cancer, risk factors for CMV reactivation, CMV prophylaxis, CMV serostatus & outcomes were collected. Multivariate logistic regression analyses (MVA) were applied to identify predictors of CMV infection, CMV end organ disease and all-cause mortality.

Results: Median age was 27y (range: 0.8-66y) and the majority were men (58%). A total of 36 (49%) patients had CMV infection out of 74 (78%) CMV seropositive recipients.  CMV infection occurred at a median of 38 days after CBT (range: -1 - +927d). Most patients had GvHD (56%), received steroids (34%), and immunosuppressive therapy (87%), mainly tacrolimus prior to CMV infection. Whether CBT recipients received CMV prophylaxis (between day -10 to -3) or not, the incidence of CMV reactivation was not statistically significant (37% vs. 43%, respectively). Progression to CMV end organ disease occurred in 6 patients at an incidence of 6% and mainly affected the gastrointestinal (GI) tract. CMV-associated mortality occurred in only 1 patient with CMV pneumonia. Non relapse related mortality occurred in 25 (26%) of CBT recipients and was not different when stratified by CMV serostatus and CMV reactivation. Univariate analysis revealed that CMV-seropositive recipients with leukemia had higher risk of developing CMV infection compared to seropositive patients with lymphoma (83% vs. 17%; p=0.039). Among CMV-seropositive recipients, more pts with CMV infection were transferred to ICU (56% vs. 34%; p=0.046) and needed mechanical ventilation (36% vs. 21%; p=0.121). MVA did not yield any significant predictors of CMV infection.

Conclusion: CMV infection after CBT is common and occurs early on after transplant. Patients with leukemia are at higher risk of this complication after CBT. Interestingly, CMV end-organ disease was not common and mainly affected the GI tract in this patient population.