Incidence, nature and mortality of cytomegalovirus infection after double-unit cord blood transplant

Abstract

Cord blood transplant (CBT) extends allograft access but is associated with a significant risk for cytomegalovirus (CMV) infection. We analyzed CMV infection in 157 CBT recipients transplanted for hematological malignancies. As compared with antigenemia testing, routine polymerase chain reaction (PCR) monitoring was associated with increased and earlier CMV infection detection (1-year incidence if seropositive 67% [median onset 41 days] vs. 100% at an earlier 33-day median [p < 0.001]) and decreased gastrointestinal disease. One-year CMV-related transplant-related mortality was 11% in CMV+ patients with 7/9 deaths associated with initial infection. Disease-free survival was lower in seropositive compared with seronegative patients (1-year: 55% vs. 73%, p = 0.02). However, in multivariate analysis adjusting for age, treatment failure risk in CMV+ patients was not significant (hazard ratio 1.52, p = 0.11). CMV infection is a major challenge in seropositive CBT recipients. While PCR surveillance permits early detection of viremia, new prophylaxis and therapeutic strategies are needed.

Keywords::

• Allogeneic transplant
• cord blood
• cytomegalovirus
• transplant-related mortality

Potential conflict of interest

Disclosure forms provided by the authors are available with the full text of this article at www.informahealthcare.com/lal.

This work was supported in part by the Gabrielle's Angel Foundation for Cancer Research (J.N.B.), the Society of Memorial Sloan-Kettering Cancer Center (J.N.B. and S.G.), the Memorial Sloan-Kettering Cancer Center Translational and Integrative Medicine Research Program (J.N.B.), the American Society of Clinical Oncology Young Investigator Award (C.S.) and P01 CA23766 from the National Cancer Institute, National Institutes of Health.