J Korean Med Sci.  2004 Apr;19(2):172-176. 10.3346/jkms.2004.19.2.172.

The Risk of Cytomegalovirus Infection in Non-myeloablative Peripheral Stem Cell Transplantation Compared with Conventional Bone Marrow Transplantation

• Oh SJ
• Lee KH
• Lee JH
• Choi SJ
• Kim WK
• Lee JS
• Kim MN

• KMID: 1733473
• DOI: http://doi.org/10.3346/jkms.2004.19.2.172

Abstract

Non-myeloablative allogeneic peripheral stem cell transplantation (NST) is a novel therapeutic strategy for patients with hematologic malignancies. Whether non-myeloablative transplants are associated with increased risk of cytomegalovirus (CMV) infections is unknown. To clarify this issue, we compared the outcome of CMV infection following 24 allogeneic non-myeloablative peripheral blood stem cell transplants and 40 conventional bone marrow transplants (CBT). The NST regimen consisted of busulfan (4mg/kg/day), fludarabine (30mg/m2) and anti-thymocyte globulin (10mg/kg). Twelve patients (50%) in the NST group and 17 (43%) in the CBT group developed positive antigenemia before day 100 (p=0.60). The time to the first appearance of positive antigenemia was not different between these two groups (p=0.40), and two groups showed similar initial and maximal antigenemia values (p=0.56 and p=0.68, respectively). Only one case of CMV colitis developed in the CBT group whereas CMV disease did not develop in the NST group. Although statistically insignificant, the treatment response against CMV antigenemia using ganciclovir was in favor of NST group. In conclusion, there was no difference in the risk of CMV infection between NST group and CBT group. Further prospective and controlled study is needed to clarify the impact of non-myeloablative procedure on the outcome of CMV infection.

Keyword

Cytomegalovirus; Hematopoietic Stem Cell Transplantation; Bone Marrow Transplantation; Ganciclovir

MeSH Terms

Adolescent
Adult
Antigens, Viral/blood
Antiviral Agents/therapeutic use
Bone Marrow Transplantation/*adverse effects/statistics & numerical data
Comparative Study
Cytomegalovirus Infections/*epidemiology/prevention & control
Female
Ganciclovir/therapeutic use
Hematopoietic Stem Cell Transplantation/*adverse effects/statistics & numerical data
Human
Incidence
Male
Middle Aged
Retrospective Studies
Risk Factors
Treatment Outcome

Figure

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  Fig. 1 Probability of developing positive CMV antigenemia after non-myeloablative and conventional transplantation shown by Kaplan-Meier curves.

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  Fig. 2 The initial (1st Ag) and maximum (Max Ag) antigenemia values, compared between non-myeloablative and conventional transplantation procedures.

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  Fig. 3 Serial changes in antigenemia values in patients receiving ganciclovir were compared between non-myeloablative and conventional transplantation.

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