Risk Factors for Predicting CMV Infection in Allogeneic-PBSCT Setting: MNC Dose, Campath Use, and Acute GVHD Grade ≥II.

Risk factors for predicting CMV infection in allogeneic-PBSCT setting: MNC dose, Campath use, and acute GVHD grade ≥II

Background: CMV infection remains an important complication of allogeneic stem cell transplantation (SCT). Campath-1H (anti-CD52) antibodies have been widely used in vivo for T-cell depletion following conventional and reduced intensity conditioning regimens and associated with a significant reduction in GVHD but at the cost of impaired immune reconstitution. We studied the risk factors, for the development of CMV infection after allogeneic SCT, including the use of Campath-1H.

Methods: From Sep. 1998 to May 2006, 122 patients who received allogeneic peripheral blood stem cell transplantation were enrolled. CMV infection was routinely sought by at least weekly screening for CMV related matrix protein pp65 antigenemia after engraftment (WBC>1,500/uL) was achieved. CMV antigenemia was treated with ganciclovir 5mg/kg twice daily i.v. as preemptive therapy for at least 10 days.

Results: The overall incidence of CMV infection was 56/122 (45.9%) cases with a median onset of 44 days post transplants. Risk factors for CMV infection in the multivariate analysis were acute graft-versus-host disease (GVHD) grade II-IV (p=0.015), use of Campath-1H in conditioning therapy (p=0.012), and mononuclear cell (MNC) doses in the transplants (p=0.010). Among conditioning therapies, the use of Campath-1H was associated with increased incidence of CMV infection (75.0%) compared with conventional conditioning therapy (40.9%)(p<0.01) and relatively early occurrence of CMV infection, median 22 days post transplant (p=0.016).

Conclusion:The incidence of CMV infection was strongly associated with acute GVHD, MNC doses, and especially Campath-1H use in an allogeneic PBSCT setting.