Safety of leukoreduced, cytomegalovirus (CMV)‐untested components in CMV‐negative allogeneic human progenitor cell transplant recipients

Nash, Tammon; Hoffmann, Sandra; Butch, Suzanne H.; Davenport, Robertson D.; Cooling, Laura

doi:10.1111/j.1537-2995.2012.03739.x

Cited by 32 publications

(36 citation statements)

References 6 publications

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“…Based on this study and subsequent retrospective and observational studies, leukoreduction has been deemed equivalent to CMV-seronegative products for TT-CMV mitigation in susceptible patient populations. [21][22][23][24] Although many institutions have adopted universal leukoreduction policies, the question of providing leukoreduced blood products that are also CMV seronegative for specific at-risk patient populations has remained unanswered.…”

Section: Discussionmentioning

confidence: 99%

Survey on Transfusion-Transmitted Cytomegalovirus and Cytomegalovirus Disease Mitigation

Weisberg¹,

Staley²,

Williams³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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Context.— Cytomegalovirus (CMV) can be transmitted by cellular blood products, leading to severe disease in immunosuppressed patients such as neonates and transplant recipients. To mitigate transfusion-transmitted CMV (TT-CMV), “CMV-safe” blood products (leukoreduced and/or CMV-seronegative) are transfused. Attempts to develop practice guidelines for TT-CMV mitigation have been limited by paucity of high-quality clinical trials. Objective.— To assess current TT-CMV mitigation strategies across medical institutions for specific at-risk populations. Design.— Supplemental questions regarding TT-CMV and CMV disease mitigation were added to a College of American Pathologists Transfusion Medicine (Comprehensive) Participant Survey in 2015, addressing whether a given institution provided CMV-safe products for 6 at-risk patient populations. Results.— Ninety percent (2712 of 3032) of institutions reported providing universally leukoreduced blood products. Among institutions without universal leukoreduction, 92% (295 of 320) provided leukoreduced products on the basis of clinical criteria. Eighty-three percent (2481 of 3004) of respondents reported having availability of CMV-seronegative products; however, wide variation in policies was reported governing CMV-seronegative product use. Among all respondents, less than 5% reported using CMV prophylaxis and monitoring in high-risk patient groups. Transplant centers reported higher rates of CMV prophylaxis (25% [97 of 394] solid organ) and monitoring (15% [59 of 394] solid organ) for CMV-negative transplant recipients. Conclusions.— Universal leukoreduction is the primary strategy for mitigating TT-CMV. While most institutions have both CMV-seronegative and leukoreduced blood products available, consensus is lacking on which patients should receive these products. High-quality studies are needed to determine if CMV-seronegative and leukoreduced blood products are needed in high-risk patient populations.

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Section: Discussionmentioning

confidence: 99%

Survey on Transfusion-Transmitted Cytomegalovirus and Cytomegalovirus Disease Mitigation

Weisberg¹,

Staley²,

Williams³

et al. 2017

Archives of Pathology &Amp; Laboratory Medicine

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“…Both studies found no risk for transfusion-transmitted CMV infection. Anti-CMV immunoglobulin G was detected in some patients in both of the studies, 83,84 but this effect was likely due to the passive transfer of antibodies during transfusions. 84 Nonetheless, the overall risk of transfusion-transmitted CMV infection in leukoreduced components is not zero.…”

Section: 72mentioning

confidence: 99%

“…82 Since then, 2 additional studies have been published with results that support the safety of using leukoreduced blood alone for the prevention of transfusion-transmitted CMV infection. 83,84 These studies focused on transfusion and transmission in patients receiving allogeneic HSCT. A total of 123 patients who were CMV negative and who had received nearly 8,000 leukoreduced but unscreened blood products were analyzed.…”

Section: 72mentioning

confidence: 99%

Transfusion Support Issues in Hematopoietic Stem Cell Transplantation

Cohn

2015

Cancer Control

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on canvas printed with an image of myxofibrosarcoma with metastases to the artist's lung, 26" × 36". Minnesota, Minneapolis, Minnesota. Submitted March 27, 2014; accepted July 23, 2014. Address correspondence to Claudia S. Cohn, MD, PhD, D242 Mayo Memorial Building, MMC 609, 420 Delaware Street, South East, Minneapolis, MN 55455. E-mail: cscohn@umn antigen (HLA) matching remains an important predictor of success with HSCT; however, the ABO barrier is often crossed when searching for the most appropriate HLA match between donor and patient. Crossing the ABO barrier has little or no effect on overall outcomes; however, complications can arise due to antigenic incompatibility between the transplanted cells and the patient. From the Department of Laboratory Medicine and Pathology, University of1 This review will discuss the transfusion support of patients receiving HSCT, common transfusion-related complications that health care professionals will likely encounter, and the measures required to safely deliver blood components.HSCTs can be broadly divided into related allogeneic, unrelated allogeneic, and autologous transplantation. Hematopoietic progenitor cells (HPCs) for allogeneic transplantation come from 3 sources: apheresis-derived, mobilized peripheral blood pro- Transfusion Support Issues in Hematopoietic Stem Cell Transplantation

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“…Although this has proven to be an effective strategy since the 1980s, it carries a significant disadvantage of excluding a large portion of the donor population with the resultant difficulties in maintaining an adequate supply of CMV-seronegative blood products. [28][29][30][31][32][33] In addition, the use of CMV-seronegative blood cannot completely eliminate the risk of TT-CMV infection, given the real possibility of window period donations. 34 However, the risk of TT-CMV infection as a result of window period donations seems to be low, especially given the previously discussed finding that the peak levels of CMV DNA in primary infection occur only after seroconversion.…”

Section: Strategies For the Reduction Of Tt-cmv Infectionmentioning

confidence: 99%

“…Accordingly, two studies published within the past 6 years each reported no cases of TT-CMV infection among a combined group of 123 D−/R− HSCT patients with a combined transfusion of ~8,000 LR/ CMV-untested (LR-only) blood products. 33,57 Based on these data, the risk of TT-CMV infection with CMV-untested blood products that undergo prestorage leukodepletion with currentgeneration LR filters seems to be very low. These findings contrast sharply with those of Wu et al who reported three cases of possible TT-CMV infection among 46 previously CMV-seronegative patients transfused with leukoreduced blood products that had not been prospectively screened for CMV status.…”

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confidence: 99%

Current strategies and future directions for the prevention of transfusion-transmitted cytomegalovirus

Harmon¹,

Cooling²

2017

IJCTM

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Cytomegalovirus (CMV) is a pervasive DNA virus that infects a significant portion of individuals worldwide, and may be transmitted through the transfusion of blood products. Although CMV infection is of little consequence in immunocompetent individuals, patients with an impaired immune system are at risk of significant morbidity and mortality. Unlike other blood-borne infectious agents, it is impractical to defer all CMV-positive individuals from blood donation as this would exclude a substantial number of otherwise eligible donors. Other methods such as transfusion of CMV-seronegative and leukoreduced blood products must be employed to prevent the transmission of CMV to at-risk patients. In this study, the widespread use of current strategies for the prevention of transfusion-transmitted CMV (TT-CMV) infection and the evidence to support these methods in various at-risk groups were reviewed. In addition, emerging pathogen inactivation technologies that have the potential to eliminate TT-CMV were also discussed.

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Safety of leukoreduced, cytomegalovirus (CMV)‐untested components in CMV‐negative allogeneic human progenitor cell transplant recipients

Cited by 32 publications

References 6 publications

Survey on Transfusion-Transmitted Cytomegalovirus and Cytomegalovirus Disease Mitigation

Survey on Transfusion-Transmitted Cytomegalovirus and Cytomegalovirus Disease Mitigation

Transfusion Support Issues in Hematopoietic Stem Cell Transplantation

Current strategies and future directions for the prevention of transfusion-transmitted cytomegalovirus

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