Cytomegalovirus Infection in Patients Who Underwent Allogeneic Hematopoietic Stem Cell Transplantation in Portugal: A Five-Year Retrospective Review

Abstract

Cytomegalovirus (CMV) infection is 1 of the leading causes of morbidity and mortality after allogeneic hematopoietic stem cell transplantation (aHSCT), mainly within the first 100 days after transplantation. We aimed to characterize CMV infection in a cohort of 305 patients with different malignancies undergoing aHSCT at the Portuguese Institute of Oncology of Porto between January 2008 and December 2012. In total, 184 patients (60.3%) developed CMV infection, mainly viral reactivations rather than primary infections (96.2% versus 3.8%, respectively). The majority of patients (166 of 184) developed CMV infection ≤100 days after transplantation, with median time to infection of 29 days (range, 0 to 1285) and median duration of infection of 10 days (range, 2 to 372). Multivariate analysis revealed that CMV infection was increased in donor (D)-/recipient (R)+ and D+/R+ (odds ratio [OR], 10.5; 95% confidence interval [CI], 4.35 to 25.4; P < .001) and in patients with mismatched or unrelated donors (OR, 2.54; 95% CI, 1.34 to 4.80; P = .004). Cox regression model showed that the risk of death was significantly increased in patients >38 years old (OR, 1.89; 95% CI, 1.14 to 3.12; P = .0137), who underwent transplantation with peripheral blood (OR, 3.02; 95% CI, 1.33 to 6.86; P = .008), with mismatched or unrelated donor (OR, 2.16; 95% CI, 1.48 to 3.13; P < .001), and who developed CMV infection (OR, 1.76; 95% CI, 1.07 to 2.90; P = .025). Moreover, patients who developed CMV infection had a significantly reduced median post-transplantation survival (16 versus 36 months; P = .002).

Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area

“…In an analysis of a Portuguese cohort that comprised 85.81% CMV-seropositive recipients and 73.27% CMV-seropositive donors, Sousa et al [14] observed that 60.3% of patients developed CMV infection after allo-HSCT. In our study, 92.68% of recipients and 85.37% of donors were CMV-seropositive, but the incidence of CMV reactivation was only 39.02%.…”

“…Sousa et al [14] found that CMV infection was associated with inferior median post-transplantation survival in allo-HSCT recipients. However, the data from our cohort did not show a statistically significant difference in OS between patients with and without CMV reactivation.…”

Investigation of Cytomegalovirus, Epstein-Barr Virus and Adenovirus Infections After Hematopoietic Stem Cell Transplantation (HSCT) in Pediatric Patients

“…Allojenik HKHT alıcıla-rında CMV majör virüslerden biridir. CMV seropozitif alıcıların %45-65'inde reaktive olur ve bu hastaların %20-30'unda CMV hastalığı gelişir [1][2][3] . CMV infeksiyonu tipik olarak, HKHT'den sonraki ilk 100 gün içinde görülür ve başlıca pnömoni ve gastrointestinal hastalığa yol açar.…”

“…İlk infeksiyon sonrasında virüs lenfositlerde, monositlerde ve dendritik hücrelerde latent kalır. Allojenik HKHT alıcılarında CMV infeksiyonu asemptomatik infeksiyondan pnömoni, hepatit, gastroenterit, retinit ve ensefalite değişen çeşitli hastalıklarla ilişkilidir [1,3,4] . Yine herpesvirüs ailesinin üyesi olan Epstein-Barr virüs (EBV) popülasyonun %90'dan fazlasını infekte eden yaygın bir virüstür.…”

Multidrug-resistant cytomegalovirus infection in a pediatric stem cell transplantation patient

“…CMV infection in HSCT patients manifests as enterocolitis, pneumonia, hepatitis or as retinitis and bone marrow suppression (Russell et al, 2011). Although less frequently, late CMV reactivation (>100 days posttransplant) can occur (Cervera et al, 2007;Sousa et al, 2014).…”