Prevention of transfusion‐transmitted cytomegalovirus infection using leukoreduced blood components in patients receiving seronegative umbilical cord blood transplantation

Abstract

BACKGROUND: Leukoreduced blood components have been widely implemented to prevent transfusiontransmitted cytomegalovirus (TT-CMV) in transplantation. Recent progress in leukoreduction technology has helped reduce the risk of TT-CMV in hematopoietic stem cell transplantation; however, its efficacy in umbilical cord blood transplantation (CBT) has not been systematically studied. STUDY DESIGN AND METHODS:We retrospectively analyzed the incidence of CMV infection in patients treated with CBT who received prestorage leukoreduced, CMV-unselected blood components between 2007 and 2017 in a single Japanese pediatric center. Patients were monitored for CMV antigenemia at least once weekly. RESULTS:In total, 71 patients treated with CBT were identified. Two patients were excluded because of unknown CMV serostatus or early death after CBT. Of the remaining 69 patients, 24 developed CMV antigenemia. Among them, 3 received granulocyte transfusions (3 of 3; 100%), 2 were infants with severe combined immunodeficiency who had been infected with CMV before CBT (2 of 2; 100%), and 19 were CMVseropositive patients (19 of 23, 82.6%). Conversely, of the remaining 45 patients in whom CMV antigenemia did not develop, 41 were seronegative (0 of 41; 0%) and were transfused with a total of 925 leukoreduced, CMVunselected blood components. Among the 41 patients, 9 (22%) received in vivo T-cell depletion with antithymocyte globulin. None of the patients in the seronegative group has subsequently shown evidence of CMV infection or developed CMV disease. CONCLUSION: Using prestorage leukoreduction, nocases of CMV infection were detected in seronegative CBT patients. Our findings showed the safety of leukoreduction in preventing TT-CMV in this patient group. ABBREVIATIONS: CB = cord blood; CBT = cord blood transplantation; CLIA = chemiluminescent immunoassay; CMV = cytomegalovirus; GTXs = granulocyte transfusions; GVHD = graftversus-host disease; HHV = human herpes virus; HLA = human leukocyte antigen; HSCT = hematopoietic stem cell transplantation; LR = leukoreduction; PCR = polymerase chain reaction; SCID = severe combined immunodeficiency; TT-CMV = transfusiontransmitted cytomegalovirus.From the

Transfusion-transmitted and community-acquired cytomegalovirus infection in seronegative solid organ transplant recipients receiving seronegative donor organs

“…In the United States, a 2017 survey reported 90% of responding institutions use leukoreduction as the primary TT-CMV prevention strategy; 40% of respondents indicated that seronegative blood use was by physician discretion in the absence of clinical guidelines. 27 Given the TT-CMV observations in our study and those in HSCT populations, [19][20][21][22][23] discontinuation of use of seronegative blood products for SOT recipients provides an evidence-based opportunity for transfusion cost reduction in settings where leukoreduced blood products are already being given. This may be further justified when the risk of TT-CMV is compared to the high incidence of donor-derived CMV and CMV reactivation when donors or recipients are seropositive; the latter risks are considered acceptable when managed using antiviral drugs and laboratory surveillance strategies.…”

“…In our previous 2002 study of SOT recipients receiving non-leukoreduced, unscreened blood products prior to universal leukoreduction we identified 3 cases of presumed TT-CMV infection, all symptomatic with fever or gastrointestinal identify any cases of TT-CMV infection among 182 recipients receiving 7903 leukoreduced and unscreened blood products. [19][20][21][22] Although Kekre et al 23 detected 1 case of TT-CMV infection when using leukoreduced blood alone, 3 cases were detected when using CMV leukoreduced and seronegative blood, suggesting that use of CMV seronegative blood in HSCT recipients when universal leukoreduction is already in place is unwarranted. Our study now demonstrates similar outcomes directly in the D−/R− SOT population, lending further support to the CMV SOT guidelines with respect to transfusion.…”

“…The evidence supporting this recommendation was extrapolated from studies of more extensively transfused hematopoietic stem cell transplant (HSCT) recipients. Four of 5 studies of D−/R− HSCT recipients failed to identify any cases of TT‐CMV infection among 182 recipients receiving 7903 leukoreduced and unscreened blood products 19‐22 . Although Kekre et al 23 detected 1 case of TT‐CMV infection when using leukoreduced blood alone, 3 cases were detected when using CMV leukoreduced and seronegative blood, suggesting that use of CMV seronegative blood in HSCT recipients when universal leukoreduction is already in place is unwarranted.…”

Assessing risks of infection with herpes viruses during transfusion of donor blood and its components

“…В литературе описаны случаи заражения герпесвирусными инфекциями при переливании донорской крови и ее компонентов [8,9]. Современная эпидемиологическая обстановка по данной группе инфекций оценивается как напряженная.…”

“…Для клеточно-ассоциированных патогенов, к которым относятся герпесвирусы, особенно актуальна лейкоредукция. Исследованиями показано, что после лейкоредукции с использованием лейкофильтров значимо снижается риск передачи ЦМВ [5,8,9], а ВЭБ после лейкофильтрации заведомо инфицированных доз концентрата тромбоцитов совсем не определяется [20]. Патогенредукция также относится к важным профилактическим мероприятиям, поскольку она эффективна в отношении большинства бактерий, простейших и вирусов, имеющих липидную оболочку [21][22][23].…”