1. ¹Department of Hematology, Nagoya University Graduate School of Medicine, Nagoya, Japan
2. ²Department of Molecular Medicine, Aichi Cancer Center, Nagoya, Japan
3. ³Department of Hematology and Chemotherapy, Aichi Cancer Center, Nagoya, Japan
4. ⁴Department of Hematology, Meitetsu Hospital, Nagoya, Japan
5. ⁵Department of Internal Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan
6. ⁶Department of Hematology and Oncology, JA Aichi Showa Hospital, Kohnan, Japan
7. ⁷Department of Hematology, Anjo Kosei Hospital, Anjo, Japan
8. ⁸Department of Hematology, Fujita Health University, Toyoake, Japan
9. ⁹Department of Internal Medicine and Molecular Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
10. ¹⁰Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan
11. ¹¹Department of Infectious Diseases, Hamamatsu Medical Center, Hamamatsu, Japan
12. ¹²Department of Hematology and Clinical Research Center, Nagoya National Hospital, Nagoya, Japan
13. ¹³Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Japan

Correspondence: Dr M Yanada, Department of Hematology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan. E-mail: myanada@med.nagoya-u.ac.jp

Received 28 January 2003; Accepted 13 May 2003.

Abstract

CMV disease remains a major infectious complication after allogeneic hematopoietic stem cell transplantation (HSCT). To investigate the relationship between CMV antigenemia, treatment with ganciclovir (GCV), and outcome, we retrospectively analyzed 241 consecutive patients at risk for CMV infection who underwent allogeneic HSCT. Antigenemia-guided pre-emptive strategy with GCV was used for all patients. CMV antigenemia developed in 169 patients (70.1%), and CMV disease in 18 patients (7.5%). Multivariate analysis showed that acute GVHD (grades II–IV) was the only risk factor for developing antigenemia, and acute GVHD and advanced age for CMV disease. GCV use, as well as acute GVHD and advanced age, significantly increased the risk for bacterial and fungal infection after engraftment. Those who developed CMV antigenemia had a poorer outcome than those who did not (log-rank, P=0.0269), although the development of CMV disease worsened the outcome with only borderline significance (log-rank, P=0.0526). In conclusion, detection of antigenemia proved to be a poor prognostic factor for HSCT patients, which may be attributed to a combination of factors, including CMV disease itself, the effect of treatment, and a host status that allows for reactivation of CMV. Optimal pre-emptive strategy needs to be determined.