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Clin Infect Dis. 2014 Aug 15;59(4):473-81. doi: 10.1093/cid/ciu364. Epub 2014 May 20.

Donor cytomegalovirus status influences the outcome of allogeneic stem cell transplant: a study by the European group for blood and marrow transplantation.

Author information

1
Department of Hematology, Karolinska University Hospital, and Division of Hematology, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
2
Department of Medical Statistics and Bioinformatics, Leiden University Medical Centre, The Netherlands.
3
Department of Hematology, Hospital de la Princesa, Madrid, Spain.
4
Sve d' Hematologie, Hôpital Henri Mondor, Creteil, France.
5
Med. Klinik und Poliklinik II, Universitätsklinikum Würzburg, Germany.
6
Pediatric Hematology and Oncology, Collegium Medicum UMK, University Hospital, Bydgoszcz, Poland.
7
Division of Infection and Immunity, University College London, United Kingdom;
8
Paediatric Haematology Oncology, Policlinico G.B. Rossi, Verona, Italy.

Abstract

BACKGROUND:

The use of a cytomegalovirus (CMV)-seronegative donor for a CMV-seronegative allogeneic hematopoietic stem cell transplant (HSCT) recipient is generally accepted. However, the importance of donor serostatus in CMV-seropositive patients is controversial.

METHODS:

A total of 49 542 HSCT patients, 29 349 seropositive and 20 193 seronegative, were identified from the European Group for Blood and Marrow Transplantation database. Cox multivariate models were fitted to estimate the effect of donor CMV serological status on outcome.

RESULTS:

Seronegative patients receiving seropositive unrelated-donor grafts had decreased overall survival (hazard ratio [HR], 1.13; 95% confidence interval [CI], 1.06-1.21; P < .0001) compared with seronegative donors, whereas no difference was seen in patients receiving HLA-matched sibling grafts. Seropositive patients receiving grafts from seropositive unrelated donors had improved overall survival (HR, 0.92; 95% CI, .86-.98; P < .01) compared with seronegative donors, if they had received myeloablative conditioning. This effect was absent when they received reduced-intensity conditioning. No effect was seen in patients grafted from HLA-identical sibling donors. The same association was found if the study was limited to patients receiving transplants from the year 2000 onward.

CONCLUSIONS:

We confirm the negative impact on overall survival if a CMV-seropositive unrelated donor is selected for a CMV-seronegative patient. For a CMV-seropositive patient, our data support selecting a CMV-seropositive donor if the patient receives a myeloablative conditioning regimen.

KEYWORDS:

CMV; donor; recipient; serological status; stem cell transplant

PMID:
24850801
DOI:
10.1093/cid/ciu364
[Indexed for MEDLINE]

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