Umbilical cord blood transplantation and cytomegalovirus: posttransplantation infection and donor screening

Albano, Maria S.; Taylor, Patricia E.; Pass, Robert F.; Scaradavou, Andromachi; Ciubotariu, Rodica; Carrier, Carmelita; Dobrila, Ludy; Rubinstein, Pablo; Stevens, Cladd E.

doi:10.1182/blood-2006-04-020313

Cited by 48 publications

(30 citation statements)

References 27 publications

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“…11,16 Among 48 CMV-seropositive patients who achieved neutrophil engraftment after CBT, 40 patients (83%) showed positive test results in the present study. This incidence of CMV infection after CBT might be higher than in the previous studies.…”

Section: Discussionsupporting

confidence: 50%

“…8,9 Previous studies have shown that CMV infection occurs frequently in adult patients after CBT. 10,11 In addition, patients with CMV infection after CBT have a higher probability of secondary graft failure than those without CMV infection. 11 Toxicity of GCV may be associated with secondary graft failure in CBT recipients with CMV infection.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Preemptive therapy with ganciclovir 5 mg/kg once daily for cytomegalovirus infection after unrelated cord blood transplantation

Tomonari

Takahashi

Ooi

et al. 2007

Bone Marrow Transplant

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The efficacy and safety of preemptive therapy using ganciclovir (GCV) 5 mg/kg once daily for CMV infection after unrelated cord blood transplantation (CBT) were studied. The initial preemptive therapy with GCV 5 mg/kg once daily led to resolution of CMV antigenemia in 25 of 34 patients (74%). In the remaining 9 patients (26%), antigenemia resolved after dose-escalation of GCV or change to foscarnet therapy. Recurrence of antigenemia was seen in 18 patients (53%). A total of 12 patients received the second preemptive therapy with GCV 5 mg/ kg once daily, which led to resolution of antigenemia in 11 of 12 patients (92%). The remaining 1 patient (8%) required change to foscarnet therapy. None of 34 patients developed CMV disease. Neutropenia with an absolute neutrophil number of less than 1 and 0.5 Â 10 9 per liter after GCV therapy occurred in 12 (35%) and 1 (3%) patients, respectively, after the initial therapy, and in 2 (17%) and 0 (0%) patients, respectively, after the second therapy. No patients developed neutropenic fever or secondary graft failure after GCV therapy. There were no deaths directly attributable to GCV therapy. The present study suggests that antigenemia-based preemptive strategy using GCV 5 mg/kg once daily is feasible and effective for CBT recipients.

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Section: Discussionsupporting

confidence: 50%

Section: Introductionmentioning

confidence: 99%

Preemptive therapy with ganciclovir 5 mg/kg once daily for cytomegalovirus infection after unrelated cord blood transplantation

Tomonari

Takahashi

Ooi

et al. 2007

Bone Marrow Transplant

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“…There is controversy as to the significance of maternal cytomegalovirus (CMV) total antibody positivity. Maternal CMV serology has no relationship with CMV infection in CBT recipients, 34 and testing of the unit by PCR is not approved by the FDA. Our institutional policy, however, is to avoid a unit with positive CMV PCR or positive CMV saliva culture on the baby.…”

Section: Other Factors In Unit Selection: Idm Sterility and Hemoglomentioning

confidence: 99%

How I treat: the selection and acquisition of unrelated cord blood grafts

Barker

Byam

Scaradavou

2011

Blood

Self Cite

145

112

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Use of unrelated donor cord blood (CB) as an alternative stem cell source is increasing, and yet there is little information to guide transplant centers in the unique aspects of the search and selection of CB grafts. There is no mechanism to easily access the global inventory of CB units, nor is the product information provided by all banks standardized. To address these challenges, this manuscript reviews the logistics of the search, selection process, and acquisition of CB grafts as practiced by our center. Topics include who should be considered for a CB search, how to access the global CB inventory, and how to balance total nucleated cell dose and human leukocyte antigen match in unit selection. We discuss aspects of unit quality and other graft characteristics (processing methods, unit age, availability of attached segments, infectious disease, and hemoglobinopathy screening) to be considered. We incorporate these considerations into a unit selection algorithm, including how to select double-unit grafts. We also describe how we plan for unit shipment and the role of backup grafts. This review aims to provide a framework for CB unit selection and help transplantation centers perform efficient CB searches. (Blood. 2011;117(8):2332-2339) IntroductionUnrelated donor cord blood transplantation (CBT) has become a widely accepted treatment for lethal hematologic diseases. Both the number of CB transplantations 1 and the global inventory of CB units (estimated at 400 000) 2 are growing rapidly. Therefore, it is critically important that transplantation centers (TCs) have a thorough understanding of how to perform a CB search as well as the challenges encountered in the selection and acquisition of CB grafts. This article is a practical guide for the TCs, especially those new to the field of CBT, and is based on our daily experience of searching the global CB inventory, our knowledge of CB banking and CB testing standards, and evaluation of recently published data. Thus, we outline our search practices at Memorial SloanKettering Cancer Center (MSKCC). Who should get a formal CB search with confirmatory HLA typing of CB unitsThere is a progressive decrease in post-transplantation survival with each human leukocyte antigen (HLA) or allele mismatch at HLA-A, -B, -C, -DRB1 loci of adult unrelated donor (URD) grafts, with donor-recipient HLA-DQ disparity being detrimental when present with other mismatches. 3 Therefore, TCs must decide what level of HLA disparity will be tolerated with a URD before alternative hematopoietic stem cell sources such as CB are sought. In addition, as CB grafts are available faster than URD, 4 transplantation urgency may be an additional reason to use CB. Prolonged URD searches are unlikely to result in acquisition of a suitably matched URD if one is not identified early in the search. 5,6 Knowledge of the patient's ancestry is critical given that patients from racial and ethnic minorities (including all those with nonEuropean ancestry) frequently do not have suitably matched URDs, 7 a result...

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“…61 The CMV source after UCBT is almost exclusively of host origin because the incidence of congenital CMV infection is very low. 62 The frequency of CMV reactivation after UCBT is variable between studies, depending on patient characteristics and pretransplant seropositivity status. In contrast, the risk of CMV infection in UCB recipients is not associated with donor serology, which reflects the maternal exposure history rather than active or latent infection.…”

Section: Clinically Prognostic Value Of Thymopoietic Recovery After Ucbtmentioning

confidence: 99%

The role of the thymus in T-cell immune reconstitution after umbilical cord blood transplantation

Politikos

Boussiotis

2014

Blood

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Umbilical cord blood (UCB) is an alternative source of hematopoietic stem cells for patients without HLA-matched adult donors. UCB contains a low number of nucleated cells and mostly naive T cells, resulting in prolonged time to engraftment and lack of transferred T-cell memory. Although the first phase of T-cell reconstitution after UCB transplantation (UCBT) depends on peripheral expansion of transferred T cells, permanent T-cell reconstitution is mediated via a central mechanism, which depends on de novo production of naive T lymphocytes by the recipient’s thymus from donor-derived lymphoid-myeloid progenitors (LMPs). Thymopoiesis can be assessed by quantification of recent thymic emigrants, T-cell receptor excision circle levels, and T-cell receptor repertoire diversity. These assays are valuable tools for monitoring posttransplantation thymic recovery, but more importantly they have shown the significant prognostic value of thymic reconstitution for clinical outcomes after UCBT, including opportunistic infections, disease relapse, and overall survival. Strategies to improve thymic entry and differentiation of LMPs and to accelerate recovery of the thymic stromal microenvironment may improve thymic lymphopoiesis. Here, we discuss the mechanisms and clinical implications of thymic recovery and new approaches to improve reconstitution of the T-cell repertoire after UCBT.

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Umbilical cord blood transplantation and cytomegalovirus: posttransplantation infection and donor screening

Cited by 48 publications

References 27 publications

Preemptive therapy with ganciclovir 5 mg/kg once daily for cytomegalovirus infection after unrelated cord blood transplantation

Preemptive therapy with ganciclovir 5 mg/kg once daily for cytomegalovirus infection after unrelated cord blood transplantation

How I treat: the selection and acquisition of unrelated cord blood grafts

The role of the thymus in T-cell immune reconstitution after umbilical cord blood transplantation

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