CMV-ANTIGENEMIA AFTER ALLOGENEIC BONE-MARROW TRANSPLANTATION - CORRELATION OF CMV-ANTIGEN POSITIVE CELL NUMBERS WITH TRANSPLANT-RELATED MORTALITY

One hundred and thirty-four consecutive patients undergoing HLA-identi cal BMT were prospectively followed on a weekly basis for the developm ent of CMV antigenemia (CMVAg-emia). End-points of the study were (1) incidence, (2) risk factors, and (3) predictive effect on transplant-r elated mortality (TRM). Fifty-six patients developed CMVAg-emia betwee n day 8-366 (median 40) with an overall actuarial risk of 43%. The med ian number of positive cells at diagnosis was 4 (range 1-48) the media n maximum number was 6.5 (range 1-435), Positive cells are expressed a s number/2.5 x 10(5) cells. In multivariate analysis, T cell depletion (TCD) (RR 2.9, P = 0.0009) and acute graft-versus-host disease (RR 2. 1, P = 0.01) were the two risk factors predictive for CMVAg-emia. The risk of developing CMV-LP was significantly higher in patients with, a s compared to patients without, CMVAg-emia (P = 0.0005) and occurred m ostly in patients who received TCD marrow (P = 0.0009) despite treatme nt with gancyclovir or foscarnet at the time of CMVAg-emia, TRM was 24 % in patients not developing CMVAg-emia; it was 21 and 47% in patients with <4> positive cells at diagnosis of CMV (P = 0.008), and 12 vs 54 % for patients with <6> positive cells during infection (P = 0.0003). Both were predictive of TRM in multivariate analysis (P = 0.04 and P = 0.002). In conclusion, the risk of developing CMVAg-emia post-allo BM T is influenced by the marrow T cell content and by the occurrence of acute GVHD. High numbers of CMV antigen positive cells are associated with considerable transplant-related mortality, and may therefore iden tify patients eligible for early aggressive therapy.