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Viral Infections

Cytomegalovirus antigenemia and outcome of patients treated with pre-emptive ganciclovir: retrospective analysis of 241 consecutive patients undergoing allogeneic hematopoietic stem cell transplantation

Bone Marrow Transplantation volume 32, pages 801–807 (2003)Cite this article

Summary:

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.

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Authors and Affiliations

  1. Department of Hematology, Nagoya University Graduate School of Medicine, Nagoya, Japan

    M Yanada, K Yamamoto, N Emi & T Naoe

  2. Department of Molecular Medicine, Aichi Cancer Center, Nagoya, Japan

    R Suzuki

  3. Department of Hematology and Chemotherapy, Aichi Cancer Center, Nagoya, Japan

    H Taji & Y Morishima

  4. Department of Hematology, Meitetsu Hospital, Nagoya, Japan

    H Iida & H Sao

  5. Department of Internal Medicine, Nagoya Ekisaikai Hospital, Nagoya, Japan

    T Shimokawa

  6. Department of Hematology and Oncology, JA Aichi Showa Hospital, Kohnan, Japan

    A Kohno & Y Morishita

  7. Department of Hematology, Anjo Kosei Hospital, Anjo, Japan

    S Mizuta

  8. Department of Hematology, Fujita Health University, Toyoake, Japan

    F Maruyama

  9. Department of Internal Medicine and Molecular Science, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan

    A Wakita

  10. Department of Hematology, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan

    K Kitaori & Y Kodera

  11. Department of Infectious Diseases, Hamamatsu Medical Center, Hamamatsu, Japan

    K Yano

  12. Department of Hematology and Clinical Research Center, Nagoya National Hospital, Nagoya, Japan

    M Hamaguchi

  13. Department of Preventive Medicine/Biostatistics and Medical Decision Making, Nagoya University Graduate School of Medicine, Nagoya, Japan

    N Hamajima

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  1. M Yanada
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  14. K Yano
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  15. M Hamaguchi
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  16. N Hamajima
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  17. Y Morishima
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Correspondence to M Yanada.

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Yanada, M., Yamamoto, K., Emi, N. et al. Cytomegalovirus antigenemia and outcome of patients treated with pre-emptive ganciclovir: retrospective analysis of 241 consecutive patients undergoing allogeneic hematopoietic stem cell transplantation. Bone Marrow Transplant 32, 801–807 (2003). https://doi.org/10.1038/sj.bmt.1704232

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