Artikel
Comparison of Cytomegalovirus Infection and Disease After Allogeneic Stem Cell Transplant from Haploidentical and Unrelated Donors in Adults with Acute Myelogenous Leukemia
Suche in Medline nach
Autoren
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H. Lee
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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S. Choi
- Korea
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S. Cho
- Korea
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D. Lee
- Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| Veröffentlicht: | 3. Juni 2014 |
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Gliederung
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Background: Haploidentical transplantation (HIT) is an acceptable procedure for patients lacking of HLA-matched donor, as outcomes of HIT have improved over the past decade. Despite of the encouraging results, there are few data regarding infectious complications after HIT. A pilot study from our center suggested that CMV infection was more frequent after HIT compared with unrelated transplantation (URT), though it had limited power due to small sample size.
Methods: We retrospectively reviewed medical records of consecutive adult patients who underwent HIT or URT for their acute myelogenous leukemia (AML) from 2009 to 2012. For CMV prophylaxis, ganciclovir during the conditioning period (D-7 to D-1), then high-dose intravenous acyclovir was administered from the D0 until engraftment to HIT recipients. Only high-dose intravenous acyclovir was administered from the D-7 until engraftment to URT recipients. We analyzed the cumulative incidence of CMV infection, preemptive therapy and diseases after HIT and compared to those in URT.
Results: A total of 183 patients (66 of HIT and 117 of URT) were included. Age, sex, and CMV serostatus were not different between HIT and URT recipients. At least one episode of CMV infection (≥500 copies/mL) was observed in 86.4% of HIT recipients at a median of 28 days (range of 11-71) and 84.6% of URT recipients at a median of 28 days (range of 9-1,352) after transplantation. Preemptive therapy for CMV was more frequently provided to HIT recipients than URT recipients (69.7% vs. 53.0%, p=.026). CMV diseases were diagnosed 15.2% in HIT group (median of 43 days [range, 22-143]) and 12.8% in URT group (median of 67 days [range, 18-403]). Of which, gastrointestinal involvement was most common in both groups (8/10 in HIT vs. 12/15 in URT). Compared by using the Gray test, competing with relapse, the cumulative incidence of CMV infection and disease did not differ significantly between HIT and URT recipients.
Conclusion: The incidence of CMV infection and diseases had no significant difference between HIT and URT recipients. Further subgroup analysis between well matched or partially matched URT and HIT recipients, considering confounding factors as conditioning regimen, is in progress.
Key words: Leukemia, Myeloid, Acute; Stem Cell Transplantation; Unrelated Donors; Cytomegalovirus
