CMV in Stem Cell Transplantation: Impact on Mortality - Infectious Diseases

Prophylactic use of ganciclovir against cytomegalovirus (CMV) infection and disease has been associated with inconsistent improvement in overall post-transplant survival. Because ganciclovir's beneficial effects are offset by its potential toxicities, CMV treatment strategies have been developed to reduce ganciclovir exposure in hosts with evidence of active CMV replication. The purpose of this observational cohort study was to determine the association of CMV serostatus with mortality in the era of ganciclovir prophylaxis among 1750 consecutive recipients of non-T-cell-depleted stem-cell transplants.

All patients were monitored weekly, from engraftment until day 100 after stem-cell transplant, for CMV reactivation or primary CMV infection, as indicated by blood cultures and pp65 antigenemia assay. CMV disease and neutropenia caused by ganciclovir administration were associated with mortality among CMV-seropositive patients. CMV-seronegative patients who had received allografts from CMV-seropositive donors had a significantly higher risk for death from bacteremia or invasive fungal infection, even after adjustment for duration of neutropenia, than CMV-seronegative patients whose donors were also CMV-seronegative.

Comment: CMV-seropositive status continues to be associated with mortality after allogeneic stem-cell transplantation, despite preemptive ganciclovir therapy. In this study, CMV donor-positive, recipient-negative hosts were at highest risk for death, and ganciclovir recipients in this group showed a trend toward lower mortality compared with nonrecipients. Better diagnostic methods are needed to determine whether, as the authors suggest, seronegative graft recipients who fare poorly may have undetected, subclinical CMV infections.

— Linda M. Mundy, MD

Published in Journal Watch Infectious Diseases February 21, 2002

Citation(s):

Nichols WG et al. High risk of death due to bacterial and fungal infection among cytomegalovirus (CMV)-seronegative recipients of stem cell transplants from seropositive donors: Evidence for indirect effects of primary CMV infection. J Infect Dis 2002 Feb 1; 185:273-82.