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Prepublished online as a Blood First Edition Paper on January 16, 2003; DOI 10.1182/blood-2002-10-3143.
Submitted October 17, 2002
Accepted January 3, 2003
Transfusion-transmitted cytomegalovirus infection after receipt of leukoreduced blood products
W Garrett Nichols*, Thomas H Price, Ted Gooley, Lawrence Corey, and Michael Boeckh
Program in Infectious Diseases, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Program in Biostatistics, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
Department of Medicine, University of Washington, Seattle, WA, USA
Puget Sound Blood Center, Seattle, WA, USA
* Corresponding author; email: gnichols{at}fhcrc.org.
Leukoreduced blood products are reportedly comparable to cytomegalovirus (CMV) seronegative products for the prevention of transfusion-transmitted CMV (TT-CMV) infection after stem cell transplantation (SCT). To determine if the incidence of TT-CMV was affected by the increasing use of leukoreduced blood products, we followed a prospective cohort of 807 CMV seronegative SCT recipients that underwent weekly surveillance using the pp65 antigenemia assay. The incidence of TT-CMV for two time periods was recorded: Period 1 (5/94-11/96), when only CMV seronegative and/or filtered blood products were provided, and Period 2 (12/96-2/00), when leukocyte reduced platelets obtained by apheresis without filtration were also used. The incidence of TT-CMV was higher during Period 2 (18/447, 4%) than Period 1 (6/360, 1.7%)(P<0.05); this was correlated with higher utilization of both filtered and apheresed products from CMV positive donors in Period 2. Multivariable analysis identified filtered RBC units (but not apheresis platelet products) from CMV positive donors as the primary predictor of TT-CMV: each additional filtered RBC unit was associated with a 32% increase in the odds for TT-CMV (95% CI 8%-61%, P=0.006). Pre-emptive therapy with ganciclovir after detection of antigenemia prevented all but one case of CMV disease prior to day 100. CMV seronegative products may thus be superior to leukoreduced products (particularly filtered RBC) for the prevention of TT-CMV. In an era of "universal leukoreduction", the abandonment of CMV seronegative inventories appears premature, particularly among populations at high risk of CMV disease that do not receive active surveillance.
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