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Prepublished online as a Blood First Edition Paper on September 12, 2002; DOI 10.1182/blood-2002-03-0993. This Article Full Text (PDF) All Versions of this Article: 2002-03-0993v1 101/2/407    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Boeckh, M. Articles by Corey, L. Search for Related Content PubMed PubMed Citation Articles by Boeckh, M. Articles by Corey, L. Social Bookmarking                   What's this? Submitted April 1, 2002 Accepted July 23, 2002 Late cytomegalovirus disease and mortality in allogeneic hematopoietic stem cell transplant recipients: importance of viral load and T-cell immunity Michael Boeckh*, Wendy Leisenring, Stanley R Riddell, Raleigh A Bowden, Meei-Li Huang, David Myerson, Terry Stevens-Ayers, Mary E D Flowers, Terri Cunningham, and Lawrence Corey Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA, USA; University of Washington, Seattle, WA, USA University of Washington, Seattle, WA, USA Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA, USA * Corresponding author; email: mboeckh{at}fhcrc.org. Ganciclovir effectively prevents cytomegalovirus (CMV) disease during the first 100 days after allogeneic hematopoietic stem cell transplantation (HSCT) but late onset CMV disease is increasingly observed. We designed a prospective cohort study to define the incidence and risk factors for late CMV infection in HSCT recipients. CMV seropositive patients were studied prospectively for CMV infection (quantitative pp65 antigenemia, quantitative CMV-DNA, blood culture), T cell immunity (CMV-specific CD4+ T helper and CD8+ cytotoxic T lymphocyte responses, CD4 and CD8 T cell count, absolute lymphocyte count) and other transplant-related factors. Univariate and multivariable analyses were used to assess the risk of late CMV infection, disease, and overall survival. Of 146 patients, 26 (17.8%) developed late CMV disease at a median day 169 after transplant (range 96-784) with a fatality rate of 46%. Thirty-eight percent of patients surviving late disease had a second episode, a median of 79 days after the first episode. At the end of 3 months after transplant, prior detection of CMV pp65 antigenemia, CD4 T cell counts < 50 per mm3, postengraftment absolute lymphopenia < 100 per mm3, undetectable CMV-specific T cell responses, GvHD were associated with late CMV disease or mortality. After 3 months, continued detection of pp65 antigenemia or CMV DNA in plasma or peripheral blood leukocytes as well as lymphopenia (< 300 per mm3) were strong predictors of late CMV disease and mortality. In conclusion, CMV viral load, lymphopenia, and CMV-specific T cell immunodeficiency are predictors of late CMV disease and mortality after allogeneic stem cell transplant. Prevention strategies should be targeted at patients who reactivated CMV during the first 3 months and those with poor CMV-specific immunity or low CD4 counts. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: A. Schub, I. G. Schuster, W. Hammerschmidt, and A. 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