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Related Collections Transplantation Clinical Trials and Observations Related Letter in Blood Online Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 March 2002, Vol. 99, No. 6, pp. 1978-1985 CLINICAL OBSERVATIONS, INTERVENTIONS, AND THERAPEUTIC TRIALS Incidence and outcome of cytomegalovirus infections following nonmyeloablative compared with myeloablative allogeneic stem cell transplantation, a matched control study Christian Junghanss, Michael Boeckh, Rachel A. Carter, Brenda M. Sandmaier, Michael B. Maris, David G. Maloney, Thomas Chauncey, Peter A. McSweeney, Marie-Térèse Little, Lawrence Corey, and Rainer Storb From the Fred Hutchinson Cancer Research Center; University of Washington; and Veterans Affairs Medical Center, Seattle, WA. Nonmyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) is increasingly being explored as therapy in patients who are not eligible for conventional myeloablative HSCT. Whether these transplants are associated with reduced risk of transplantation-related infections is unknown. We analyzed the incidence of posttransplantation cytomegalovirus (CMV) infections in 56 consecutive mycophenolate mofetil (MMF) patients with hematologic malignancies who underwent nonmyeloablative HSCT (TBI, 2Gy, day 0; MMF/cyclosporine after transplantation). In addition, 18 of 56 patients received 30 mg/m2/d fludarabine on days 4 to 2. Most donors were HLA matched and related (93%). Each case patient was matched to 2 controls who were treated by conventional HSCT during the same time period (January 1997 through April 2000). Matching criteria included CMV risk group, HSC source, donor type, age, and underlying diseases. No CMV disease occurred in the low (donor and recipient serologically negative) and intermediate (donor serologically positive and recipient negative) CMV risk groups during the first 100 days. Among cases at high risk for CMV (seropositive recipients), trends to less CMV antigenemia (P = .11), viremia (P = .16), and disease (P = .08) compared with controls were observed; all severe manifestations combined (CMV viremia and disease) were significantly reduced among cases (P = .01). However, by day 365, the overall incidence of CMV disease became similar in both groups. The onset of CMV disease was significantly delayed among case patients compared with controls (median, 130 days versus 52 days; P = .02). It was concluded that CMV disease was significantly delayed in nonmyeloablative cases, but that the overall 1-year incidence was similar to myeloablative HSCT patients. Therefore, nonmyeloablative HSCT patients should receive CMV surveillance beyond day 100 and pre-emptive ganciclovir treatment similar to that of myeloablative HSCT patients. © 2002 by The American Society of Hematology.   CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? Related Letter in Blood Online: Chimerism induction and delayed onset of cytomegalovirus (CMV) infection after allogeneic reduced-intensity stem cell transplantation (RIST) Kunihisa Nakai, Shin Mineishi, Masahiro Kami, Yoshinobu Kanda, Ryuji Tanosaki, Yoichi Takaue, Christian Junghanss, Rainer Storb, and Michael Boeckh Blood 2002 100: 2674-2675. [Full Text] [PDF] This article has been cited by other articles: J. T. Schiffer, K. Kirby, B. Sandmaier, R. Storb, L. Corey, and M. 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Windawi, J. Ritz, R. M. Stone, et al. Comparative outcome of nonmyeloablative and myeloablative allogeneic hematopoietic cell transplantation for patients older than 50 years of age Blood, February 15, 2005; 105(4): 1810 - 1814. [Abstract] [Full Text] [PDF] N. Singh and D. L. Paterson Aspergillus Infections in Transplant Recipients Clin. Microbiol. Rev., January 1, 2005; 18(1): 44 - 69. [Abstract] [Full Text] [PDF] F. Baron, J. E. Baker, R. Storb, T. A. Gooley, B. M. Sandmaier, M. B. Maris, D. G. Maloney, S. Heimfeld, D. Oparin, E. Zellmer, et al. Kinetics of engraftment in patients with hematologic malignancies given allogeneic hematopoietic cell transplantation after nonmyeloablative conditioning Blood, October 15, 2004; 104(8): 2254 - 2262. [Abstract] [Full Text] [PDF] R. Diaconescu, C. R. Flowers, B. Storer, M. L. Sorror, M. B. Maris, D. G. Maloney, B. M. Sandmaier, and R. 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