Cytomegalovirus Infection according to Cell Source after Hematopoietic Cell Transplantation in Pediatric Patients
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Purpose: This study was performed in order to evaluate the incidence and characteristics of cytomegalovirus (CMV) infection in children with acute leukemia according to donor source and graft type. Materials and Methods: We retrospectively identified children with acute leukemia who had received allogeneic hematopoietic cell transplantation at Samsung Medical Center in Korea from October 1998 to December 2009. Results: In total, 134 recipients were identified. The patients were classified into the following three groups: unrelated cord blood (CB, n=36), related bone marrow or peripheral blood stem cells (RD, n=41), and unrelated bone marrow or peripheral blood stem cells (UD, n=57). The 365-day cumulative incidence of CMV antigenemia was not significantly different among the three groups (CB 67% vs. RD 49% vs. UD 65%, p=0.17). However, CB recipients had the highest median value of peak antigenemia (CB 160/2×105 leukocytes vs. RD 7/2×105 leukocytes vs. UD 19/2×105 leukocytes, p<0.01) and the longest duration of CMV antigenemia than the other stem cell source recipients (CB 87 days vs. RD 17 days vs. UD 28 days, p<0.01). In addition, the 730-day cumulative incidence of CMV disease was the highest in the CB recipients (CB 36% vs. RD 2% vs. UD 5%, p<0.01). Thirteen CB recipients developed CMV disease, in which five of them had more than one organ involvement. Two patients, who were CB recipients, died of CMV pneumonia. Conclusion: This study suggests that CB recipients had both longer and higher cumulative incidences of CMV infection. Therefore, a more aggressive and effective strategy of CMV management should be considered in CB recipients.
Abstract
Purpose: This study was performed in order to evaluate the incidence and characteristics of cytomegalovirus (CMV) infection in children with acute leukemia according to donor source and graft type. Materials and Methods: We retrospectively identified children with acute leukemia who had received allogeneic hematopoietic cell transplantation at Samsung Medical Center in Korea from October 1998 to December 2009. Results: In total, 134 recipients were identified. The patients were classified into the following three groups: unrelated cord blood (CB, n=36), related bone marrow or peripheral blood stem cells (RD, n=41), and unrelated bone marrow or peripheral blood stem cells (UD, n=57). The 365-day cumulative incidence of CMV antigenemia was not significantly different among the three groups (CB 67% vs. RD 49% vs. UD 65%, p=0.17). However, CB recipients had the highest median value of peak antigenemia (CB 160/2×105 leukocytes vs. RD 7/2×105 leukocytes vs. UD 19/2×105 leukocytes, p<0.01) and the longest duration of CMV antigenemia than the other stem cell source recipients (CB 87 days vs. RD 17 days vs. UD 28 days, p<0.01). In addition, the 730-day cumulative incidence of CMV disease was the highest in the CB recipients (CB 36% vs. RD 2% vs. UD 5%, p<0.01). Thirteen CB recipients developed CMV disease, in which five of them had more than one organ involvement. Two patients, who were CB recipients, died of CMV pneumonia. Conclusion: This study suggests that CB recipients had both longer and higher cumulative incidences of CMV infection. Therefore, a more aggressive and effective strategy of CMV management should be considered in CB recipients.
참고문헌 (38)
- Nakamura R, "Persisting posttransplantation cytomegalovirus antigenemia correlates with poor lymphocyte proliferation to cytomegalovirus antigen and predicts for increased late relapse and treatment failure", Biol Blood Marrow Transplant, 10, pp.49~57 (2004)
- Nichols WG, "High risk of death due to bacterial and fungal infection among cytomegalovirus (CMV)-seronegative recipients of stem cell transplants from seropositive donors: evidence for indirect effects of primary CMV infection", J Infect Dis, 185, pp.273~282 (2002)
- Boeckh M, "Cytomegalovirus in hematopoietic stem cell transplant recipients: current status, known challenges, and future strategies", Biol Blood Marrow Transplant, 9, pp.543~558 (2003)
- Matsumura T, "Cytomegalovirus infections following umbilical cord blood transplantation using reduced intensity conditioning regimens for adult patients", Biol Blood Marrow Transplant, 13, pp.577~583 (2007)
- Mori T, "Cytomegalovirus infection", disease after hematopoietic stem cell transplantation, 2010, pp.91, 588~595
- Ljungman P, "Cytomegalovirus in hematopoietic stem cell transplant recipients", Hematol Oncol Clin North Am, 25, pp.151~169 (2011)
- Einsele H, "Risk factors for treatment failures in patients receiving PCR-based preemptive therapy for CMV infection", Bone Marrow Transplant, 25, pp.757~763 (2000)
- Ljungman P, "Risk factors for the development of cytomegalovirus disease after allogeneic stem cell transplantation", Haematologica, 91, pp.78~83 (2006)
- Marty FM, "Sirolimus-based graft-versus-host disease prophylaxis protects against cytomegalovirus reactivation after allogeneic hematopoietic stem cell transplantation: a cohort analysis", Blood, 110, pp.490~500 (2007)
- Ljungman P, "Results of different strategies for reducing cytomegalovirus- associated mortality in allogeneic stem cell transplant recipients", Transplantation, 66, pp.1330~1334 (1998)
- Martino R, "Severe infections after allogeneic peripheral blood stem cell transplantation: a matched-pair comparison of unmanipulated and CD34+ cell-selected transplantation", Haematologica, 86, pp.1075~1086 (2001)
- Walker CM, "Cytomegalovirus infection after allogeneic transplantation: comparison of cord blood with peripheral blood and marrow graft sources", Biol Blood Marrow Transplant, 13, pp.1106~1115 (2007)
- Miller W, "Cytomegalovirus infection after bone marrow transplantation: an association with acute graft-v-host disease", Blood, 67, pp.1162~1167 (1986)
- Schoemans H, "Adult umbilical cord blood transplantation: a comprehensive review", Bone Marrow Transplant, 38, pp.83~93 (2006)
- Harris DT, "Phenotypic and functional immaturity of human umbilical cord blood T lymphocytes", Proc Natl Acad Sci U S A, 89, pp.10006~10010 (1992)
- Brown JA, "Umbilical cord blood transplantation: basic biology and clinical challenges to immune reconstitution", Clin Immunol, 127, pp.286~297 (2008)
- Takami A, "High incidence of cytomegalovirus reactivation in adult recipients of an unrelated cord blood transplant", Haematologica, 90, pp.1290~1292 (2005)
- Parody R, "Severe infections after unrelated donor allogeneic hematopoietic stem cell transplantation in adults: comparison of cord blood transplantation with peripheral blood and bone marrow transplantation", Biol Blood Marrow Transplant, 12, pp.734~748 (2006)
- Barker JN, "Serious infections after unrelated donor transplantation in 136 children: impact of stem cell source", Biol Blood Marrow Transplant, 11, pp.362~370 (2005)
- Ljungman P, "Definitions of cytomegalovirus infection and disease in transplant recipients", Clin Infect Dis, 34, pp.1094~1097 (2002)
- Albano MS, "Umbilical cord blood transplantation and cytomegalovirus: posttransplantation infection and donor screening", Blood, 108, pp.4275~4282 (2006)
- Przepiorka D, "Hows J, et al. 1994 Consensus Conference on Acute GVHD Grading", Bone Marrow Transplant, 15, pp.825~828 (1995)
- Horwitz ME, "Chronic graft-versus-host disease", Blood Rev, 20, pp.15~27 (2006)
- Gray RJ, "A Class of K-sample tests for comparing the cumulative incidence of a competing risk", The Annals of Statistics, 16, pp.1141~1154 (1988)
- Fine J, "A proportional hazards model for the subpopulation of a competing risk", Journal of the American Statistical Association, 94, pp.496~509 (1999)
- Emery VC, "Application of viral-load kinetics to identify patients who develop cytomegalovirus disease after transplantation", Lancet, 355, pp.2032~2036 (2000)
- Rocha V, "Comparison of outcomes of unrelated bone marrow and umbilical cord blood transplants in children with acute leukemia", Blood, 97, pp.2962~2971 (2001)
- Komanduri KV, "Delayed immune reconstitution after cord blood transplantation is characterized by impaired thymopoiesis and late memory T-cell skewing", Blood, 110, pp.4543~4551 (2007)
- Ljungman P, "Randomized study of valacyclovir as prophylaxis against cytomegalovirus reactivation in recipients of allogeneic bone marrow transplants", Blood, 99, pp.3050~3056 (2002)
- Reusser P, "Cytomegalovirus (CMV)-specific T cell immunity after renal transplantation mediates protection from CMV disease by limiting the systemic virus load", J Infect Dis, 180, pp.247~253 (1999)
- Tomblyn M, "Guidelines for preventing infectious complications among hematopoietic cell transplantation recipients: a global perspective", Biol Blood Marrow Transplant, 15, pp.1143~1238 (2009)
- Reusser P, "Cytotoxic T-lymphocyte response to cytomegalovirus after human allogeneic bone marrow transplantation: pattern of recovery and correlation with cytomegalovirus infection and disease", Blood, 78, pp.1373~1380 (1991)
- Tomblyn M, "Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective", Preface. Bone Marrow Transplant, 44, pp.453~455 (2009)
- Center for International Blood and Marrow Transplant Research (CIBMTR), "National Marrow Donor Program (NMDP); European Blood and Marrow Transplant Group (EBMT); American Society of Blood and Marrow Transplantation (ASBMT); Canadian Blood and Marrow Transplant Group (CBMTG); Infectious Disease Society of America (IDSA); Society for Healthcare Epidemiology of America (SHEA); Association of Medical Microbiology and Infectious Diseases Canada (AMMI); Centers for Disease Control and Prevention (CDC). Guidelines for preventing infectious complications among hematopoietic cell transplant recipients: a global perspective", Bone Marrow Transplant, 44, pp.453~558 (2009)
- Tomonari A, "Cytomegalovirus infection following unrelated cord blood transplantation for adult patients: a single institute experience in Japan", Br J Haematol, 121, pp.304~311 (2003)
- Remberger M, "Dose study of thymoglobulin during conditioning for unrelated donor allogeneic stem-cell transplantation", Transplantation, 78, pp.122~127 (2004)
- Meyers JD, "Acyclovir for prevention of cytomegalovirus infection and disease after allogeneic marrow transplantation", N Engl J Med, 318, pp.70~75 (1988)
- Prentice HG, "Impact of long-term acyclovir on cytomegalovirus infection and survival after allogeneic bone marrow transplantation. European Acyclovir for CMV Prophylaxis Study Group", Lancet, 343, pp.749~753 (1994)