Results of different strategies for reducing: Cytomegalovirus-associated mortality in allogeneic stem cell transplant recipients

Background. Several preventive strategies against cytomegalovirus (CMV) dis ease have been developed during the last decade. These have frequently been used in combination, and it has been difficult to identify each strategy's contribution, Methods. Risk factors for CMV disease, death in CMV disease and transplant- related mortality were analyzed in 584 patients, who underwent a total of 5 94 allogeneic bone marrow transplants. Results, The overall probability of CMV disease was 8.9%. No seronegative p atient who had a seronegative marrow donor developed CMV disease. The corre sponding probabilities for seronegative patients with seropositive donors, seropositive patients with seronegative donors, and seropositive patients w ith seropositive donors were 5.4%, 13.7%, and 11.7%, respectively. In multi variate Cox models, the use of preemptive antiviral therapy and being CMV-s eronegative reduced the risk for CMV disease, CMV-associated death, and tra nsplant-related mortality (TRM). Patients who received unrelated or mismatc hed family donor transplants had increased risks for CMV disease, CMV-assoc iated death, and TRM, Older age was a significant risk factor for CMV disea se and TRM. A total of 258 patients who were monitored by polymerase chain reaction for CMV DNA were analyzed separately to assess whether addition of another CMV preventive strategy could give benefit, Patients who received mismatched or unrelated donor transplants had increased risk for CMV diseas e, death in CMV disease and TRM, High-dose acyclovir prophylaxis or additio n of intravenous immune globulin had no influence. Conclusions, Preemptive therapy based on polymerase chain reaction for CMV DNA was associated with reduced risks for CMV disease, CMV-associated death , and TRM, whereas other prophylactic modalities did not give additional be nefit.