CMV antigenemia following bone marrow transplantation: Risk factors and outcomes

Cytomegalovirus (CMV) infection remains a major problem in blood and bone m arrow transplant (BMT) recipients. Recent efforts have been directed at pre vention, early diagnosis, and treatment of CMV disease following BMT. Assay for CMV early antigen pp65 on circulating leukocytes has been shown to be sensitive and specific in detecting early CMV infection. We examined the fr equency, risk factors, and outcomes of a positive CMV antigen assay in 118 consecutive BMT patients. Forty-three (36%) of the 118 patients developed C MV antigenemia a median of 26 days post-EMT (range, -6 to 209 days). The in cidence of antigenemia in autologous, related donor, and unrelated donor BM T recipients was 15%, 50%, and 48%, respectively (P <.01) and was lower in CMV-seronegative patients (19% versus 51% in seropositive patients; P <.01) . Patients with grade TI to TV acute graft-versus-host disease (GVHD) had 2 .2 times the risk of antigenemia of patients with no or only limited GVHD ( P =.03). Age at transplantation, underlying disease, CMV prophylaxis regime n, and GVHD prophylaxis regimen did not affect the risk of CMV antigenemia. Ten of the 43 antigenemic patients, all CMV-seropositive allogeneic BMT (a lloBMT) recipients, developed CMV organ disease a median of 101 days (range , 28-283 daya) post-BMT. These data suggest that CMV-seropositive alloBMT p atients are at highest risk for CMV antigenemia and for organ disease as we ll. CMV disease may occur before antigenemia is detectable in leukopenic pa tients and may also develop late post-BMT even in patients still receiving antiviral prophylaxis. In high-risk groups, intensive surveillance continui ng for more than 6 months after BMT may be indicated.