Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan

Abstract

Summary. Cytomegalovirus (CMV) infection in 28 adult patients after cord blood transplantation (CBT) from unrelated donors was compared with that after bone marrow transplantation from HLA (human leucocyte antigen)-matched related (R-BMT) and unrelated (U-BMT) donors. Positive CMV antigenaemia was seen in 19 (79%) of 24 CMV-seropositive patients at a median of 42 d (range 29-85 d) after CBT, but in zero of four CMV-seronegative patients. This did not differ significantly from values observed after R-BMT and U-BMT (66%, P ¼ 0AE22, and 60%, P ¼ 0AE15 respectively). Based on the antigenaemia results, 16 patients (67%) received pre-emptive ganciclovir therapy from a median of 47 d (range 36-67 d) after CBT. This proportion was higher than that observed after R-BMT (28%, P ¼ 0AE0048), but did not differ from that after U-BMT (50%, P ¼ 0AE21). In addition, the probability of requiring more than two courses of ganciclovir therapy after CBT (21%) was higher than after R-BMT and U-BMT (0%, P ¼ 0AE015 and 0AE039 respectively). One patient (5%) developed CMV disease after U-BMT, whereas no patients developed CMV disease after CBT or R-BMT. The CMV serostatus, use of a steroid and HLA disparity affected the probability of requiring ganciclovir therapy after CBT (P ¼ 0AE024, 0AE032 and 0AE017 respectively). These results suggest that recovery of CMV-specific immunity after CBT is delayed when compared with BMT.

Single-institute comparative analysis of unrelated bone marrow transplantation and cord blood transplantation for adult patients with hematologic malignancies

“…The shorter time from donor search to transplantation and low steroid therapy requirements for GVHD might be significant factors contributing to this improvement. Although the positive CMV antigenemia rate and incidence of preemptive ganciclovir therapy among CB transplant recipients tended to be higher than among BM transplant recipients, 24 no clinical CMV infection was observed in any recipients after CBT (data not shown), probably because steroids were not required in most cases. A significantly lower incidence of infection as a cause of death in CBT patients was also observed in our series.…”

“…All cord blood grafts were evaluated by HLA-A, HLA-B, and HLA-DRB1 typing and nucleated cell counts. Minor mismatch 11 (24) 20 (29) Major mismatch 18 (40) 28 (41) CMV indicates cytomegalovirus; AML, acute myelogenous leukemia; CR1, CR2, first and second complete remission; Advanced, patients in third complete remission, relapse, CML beyond chronic phase, or who had high-risk cytogenetics were classified as high risk; ALL, acute lymphoblastic leukemia; CML, chronic myelogenous leukemia; CP, chronic phase; MDS, myelodysplastic syndrome; RA, refractory anemia; NHL, non-Hodgkin lymphoma; TBI, total body irradiation; Ara-C, cytosine arabinoside; G-CSF, granulocyte colony-stimulating factor; CY, cyclophosphamide; CsA, cyclosporine; sMTX, short-term methotrexate; FK506, tacrolimus; and mPSL, methylprednisolone.…”

Outcome of alloanergized haploidentical bone marrow transplantation after ex vivo costimulatory blockade: results of 2 phase 1 studies

“…Although the incidence of CMV reactivation in our study was lower than that in recent reports of nsTCD haploidentical HSCT, many such studies used detection techniques with greater sensitivity. 42,[44][45][46] However, the CMV reactivation observed was associated with high rates of fatal CMV disease in many such studies; up to 60% of TRM was related to CMV infection and up to 16% of all patients transplanted died from human herpesvirusrelated infections, the majority from CMV. 4,43 In our studies, there was no CMV-related TRM.…”

Umbilical cord blood transplantation: Basic biology and clinical challenges to immune reconstitution

“…Investigators from Japan reported cytomegalovirus (CMV) infection following UCB in 28 adults compared with sibling matched (R-BMT) and URD BM recipients. CMV antigenemia was observed in 19 (79%) of UCB patients at median 42 days [75]. A higher proportion of UCB patients treated with preemptive gancyclovir therapy required a second course of treatment compared with R-BMT and URD BM patients, suggesting that CMV-specific immunity after UCB may be delayed.…”