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Effect of conditioning regimen intensity on CMV infection in allogeneic hematopoietic cell transplantation.

Nakamae, Hirohisa and Kirby, Katharine A and Sandmaier, Brenda M and Norasetthada, Lalita and Maloney, David G and Maris, Michael B and Davis, Chris and Corey, Lawrence and Storb, Rainer and Boeckh, Michael (2009) Effect of conditioning regimen intensity on CMV infection in allogeneic hematopoietic cell transplantation. Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation, 15 (6). pp. 694-703. ISSN 1523-6536

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Nonmyeloablative conditioning is less toxic and results in initial establishment of mixed hematopoietic T cell chimerism for up to half a year with prolonged presence of host T cell immunity. In this study, we examined whether this translates into differences in the risks and/or severity of cytomegalovirus (CMV) infection and disease. We analyzed data from 537 nonmyeloablative (NM-HCT) and contemporaneous 2489 myeloablative hematopoietic cell transplant (M-HCT) recipients. In CMV seropositive recipients, no difference in the overall hazards of CMV infection at any level (adjusted hazard ratio [adj. HR] 0.9, 95% confidence interval [95% CI]: 0.7-1.0, P = .14) was noted; however, NM-HCT was associated with a lower risk of high-grade CMV infection (adj. HR 0.7, 95% CI: 0.5-0.9, P = .02). CMV disease rates were similar between the groups during the first 100 days after HCT, but NM-HCT recipients had an increased risk of late CMV disease (adj. HR 2.0, 95% CI 1.2-3.4). The increased risk of late CMV disease after NM-HCT was pronounced during the earlier years of the study period, but not detectable in more recent years. Contrary to earlier reports, survival following CMV disease was not reduced after NM-HCT when compared to M-HCT recipients. These results suggest that residual host cells after NM-HCT reduce progression to higher CMV viral load in NM-HCT recipients; however, this effect does not appear to protect against serious complications of CMV. Therefore, CMV prevention strategies in NM-HCT recipients should be similar to those used in M-HCT recipients.

Item Type: Article or Abstract
Additional Information: This article is available to subscribers only via the URL above.
DOI: 10.1016/j.bbmt.2009.02.009
PubMed ID: 19450754
PMCID: PMC2763357
Grant Numbers: CA 18029, CA15704, HL36444, CA78902
Keywords or MeSH Headings: * Adolescent * Adult * Aged * Aged, 80 and over * Anti-Infective Agents/therapeutic use * Bacterial Infections/drug therapy * Bacterial Infections/epidemiology * Child * Child, Preschool * Cohort Studies * Cytomegalovirus Infections/drug therapy * Cytomegalovirus Infections/epidemiology * Cytomegalovirus Infections/etiology* * Cytomegalovirus Infections/immunology * Cytomegalovirus Infections/prevention & control * Cytomegalovirus Infections/transmission * Disease Susceptibility * Female * Graft vs Host Disease/prevention & control * Hematopoietic Stem Cell Transplantation/adverse effects* * Humans * Immunologic Memory * Immunosuppressive Agents/therapeutic use * Incidence * Infant * Male * Middle Aged * Mycoses/drug therapy * Mycoses/epidemiology * Myeloablative Agonists/administration & dosage * Myeloablative Agonists/adverse effects* * Postoperative Complications/drug therapy * Postoperative Complications/epidemiology * Postoperative Complications/etiology* * Postoperative Complications/immunology * Postoperative Complications/prevention & control * Retrospective Studies * Risk * T-Lymphocyte Subsets/immunology * Transplantation Conditioning/adverse effects * Transplantation Conditioning/methods* * Transplantation, Homologous/adverse effects * Viremia/epidemiology * Viremia/etiology * Viremia/immunology * Whole-Body Irradiation/adverse effects* * Young Adult
Subjects: Diseases > Viral diseases
Therapeutics > Transplantation > Stem Cell transplantation
Depositing User: Library Staff
Date Deposited: 17 Jun 2009 15:48
Last Modified: 14 Feb 2012 14:42

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