The importance of pre bone marrow transplantation serology in determining subsequent cytomegalovirus infection. An analysis of risk factors.

Abstract

The yearly incidence of cytomegalovirus (CMV) infection among 73 consecutive bone marrow transplant (BMT) recipients was 68%. Recipients with negative CMV serology prior to transplantation had a yearly incidence of CMV infection of 35% compared to 87% in CMV seropositive patients (p = 0.0001). When the ages of donors and recipients were analysed as continuous variables, both recipients with a younger donor and young recipients had a lower incidence of CMV infection (p = 0.04; p = 0.05). White cell transfusions were significantly associated with an increased incidence of CMV infection (p = 0.03). If white cell transfusions were controlled for, lower marrow cell doses were significantly associated with an increased risk of CMV infection, compared to higher cell doses (p = 0.035). In multivariate analyses, the impact of negative recipient serology was so strong that the other analysed factors did not affect the prognosis for CMV infection, when taken together or separately. 14 patients had symptomatic CMV infection and 13 of those were seropositive prior to BMT. The one-year incidence of symptomatic CMV infection was 33%. None of 12 clinical factors analysed were significantly associated with symptomatic CMV infection. The CMV antibody titer level prior to BMT was not correlated to the risk for symptomatic CMV infection and/or death. The ability to respond with a significant titer rise after BMT was lowered for patients with interstitial pneumonitis compared to patients with other clinical symptoms of CMV infection.