Human Cytomegalovirus In Hematopoietic Stem Cell Transplant Recipients. A single center experience
Background: Herperviruses remain latent after primary infection and may reactivate under immunosuppressive conditions. Our study is focused on Cytomegalovirus (CMV) in hematopoietic stem cell transplantation (HSCT) recipients, as this virus may be a major cause of post-HSCT complications. The study was designed to evaluate the incidence of CMV DNAemia and its associated factors in autologous (auto) and allogeneic (allo) HSCT recipients. In addition, estimate the necessity for regular monitoring of CMV DNAemia in auto-HSCT recipients.
Methods: This prospective study included forty patients undergoing auto and allo-HSCT at the Bone marrow transplant unit. CMV DNA in plasma was detected by PCR weekly in allo-HSCT recipients from post-transplantation week 2 until day 70 post-HSCT. For auto-HSCT recipients, PCR was done at weeks 2,4,6 and whenever CMV was clinically suspected.
Results: CMV DNA was detected in 13/40 (32.5%) of HSCT recipients at a median of 6 weeks post-HSCT. CMV reactivation occurred in 3/12 (25%) of allo- HSCT recipients, and 10/28 (35.7%) of auto-HSCT recipients (p=0.716). No significant association was noted for age, gender, underlying disease, conditioning regimen, pre-HSCT CMV serology with CMV reactivation. Acute graft versus host disease (aGVHD) occurred in (66.7%) of CMV positive allo-patients (p=0.05).CMV was asymptomatic in (90%) of auto-HSCT recipients.
Conclusion: CMV DNAemia is common after HSCT. CMV DNA routine monitoring and preemptive treatment is essential in allo-HSCT recipients as they are more prone to symptomatic CMV disease. We propose that serial post-transplant PCR monitoring in auto-HSCT is not necessary in the absence of clinical manifestations or pathologic evidence suggestive for CMV disease, supporting the protocol followed at the bone marrow transplant unit.