Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: Single-centre experience

The aim of this study was to analyse the incidence and risk factors for cytomegalovirus infection (CMV-I) and disease (CMV-D) after a reduced intensity conditioning allogeneic hematopoietic stem cell transplantation (alloHSCT-RIC). We included 186 consecutive alloHSCT-RIC adult patients at risk for CMV reactivation (patient andor donor CMV seropositivity). Conditioning regimen was based on fludarabine plus an alkylating agent. For guiding pre-emptive anti-CMV therapy, Pp65 Antigenemia (pp65Ag) (n116) or quantitative polymerase chain reaction (quantPCR) (n70) were used. The 2-year incidence of CMV-I andor CMV-D was 36 (11 for CMV-D). Of note, 1214 (86) episodes of CMV-D in the pp65Ag group had lung involvement compared with only 315 (20) in the quantPCR group (P0.01). Importantly, the number of patients who developed CMV pneumonia with prior negative screening tests was unusually high (67 overall). Multivariate analysis of risk factors for CMV-D identified two risk factors: (i) steroid therapy for moderate-to-severe graft-vs-host disease (GVHD) (hazard ratio 4.7, P0.02); and (ii) alternative donors (non-HLA-identical siblings) hazard ratio 2.7, P0.002. Our findings suggest that CMV is still a major concern in alloHSCT-RIC. Variables associated with poor anti-CMV T-cell recovery (that is, GVHD and donor type) are helpful in identifying patients at higher risk for CMV-D in the alloHSCT-RIC setting. © 2010 Macmillan Publishers Limited.