Cytomegalovirus infection monitoring in patients with long-term survival after allogeneic hematopoietic stem cell transplantation

Abstract

To analyze the cytomegalovirus (CMV) infection status and the risk factors in patients with long-term survival after allogeneic hematopoietic stem cell transplantation (allo-HSCT). 159 long-term survivors receive allo-HSCT from January 2008 through December 2011 in the Bone Marrow Transplantation Center of Zhejiang University were included, CMV-pp65 antigen in peripheral blood leukocytes was detected by immunofluorescence assay at regular intervals, to retrospectively analyzed the clinical data. Ganciclovir or foscarnet was used for prevent and curative therapy. A total of 159 patients with long-term survival at 18-66 months after allo-HSCT were investigated. And 8 047 specimens were detected, including 2 553 positive samples. All patients were at least one time positive for CMV-pp65 antigen after allo-HSCT. The CMV antigen positive rate increased gradually from 100 days after transplantation to within 100 days until 1 year while the positive rate decreased, after 1 year. The difference was statistically significant (all P < 0.01). The CMV antigen positive rate in patients after non-myeloablative allo-HSCT (NST) and those after myeloablative allo-HSCT were 167/608(27.5%) and 2 386/7 439 (32.1%) respectively. The difference was statistically significant (P = 0.019). No statistically significant difference existed between those with acute graft-versus-host disease (aGVHD) and chronic graft-versus-host disease (cGVHD) (both P > 0.05). The CMV antigen positive rate in patients with I-IIgrade aGVHD and those with III-IV grade aGVHD were 1 017/3 284(31.0%) and 227/641(35.4%) respectively. And it had statistically significant difference (P = 0.027). The CMV antigen positive rate in patients none-used of ATG and those used of ATG were 1 255/3 755 (33.4%) and 1 298/4 292 (30.2%) respectively. And it had statistically significant difference (P = 0.002). By Logistic multivariate analysis, the none-use of ATG and III-IV grade aGVHD were the risk factors for CMV antigen positive after allo-HSCT (OR = 1.174, 95%CI:1.068-1.290, P = 0.001;OR = 1.174, 95%CI:0.681-0.958, P = 0.014). Regular monitoring of CMV-pp65 antigen after allo-HSCT is quite necessary for prevent and treat CMV infection in a timely manner. The CMV infection in long-term survival patients may be related to the selection of conditioning regimen, it has no obvious correlation with the incidence of GVHD, but it is associated with the severity of aGVHD.