Ann Hematol (2015) 94:481–489 DOI 10.1007/s00277-014-2222-x
ORIGINAL ARTICLE
Cytomegalovirus infection in seropositive unrelated cord blood recipients: a study of 349 Korean patients Meerim Park & Young Ho Lee & Soo Hyun Lee & Keon Hee Yoo & Ki Woong Sung & Hong Hoe Koo & Ji Won Lee & Hyoung Jin Kang & Kyung Duk Park & Hee Young Shin & Hyo Seop Ahn & Jae Wook Lee & Nack-Gyun Chung & Bin Cho & Hack-Ki Kim & Kyung-Nam Koh & Ho Joon Im & Jong Jin Seo & Hee Jo Baek & Hoon Kook & Tai Ju Hwang & Jae Min Lee & Jeong Ok Hah & Yeon Jung Lim & Jun Eun Park & Chuhl Joo Lyu & Young Tak Lim & So Young Chong & Doyeun Oh & on behalf of the Cord Blood Transplantation Working Party of the Korean Society of Hematology
Received: 4 March 2014 / Accepted: 24 September 2014 / Published online: 25 November 2014 # Springer-Verlag Berlin Heidelberg 2014
Abstract To gain insight into the natural history of cytomegalovirus (CMV) infection following unrelated cord blood transplantation (UCBT) in seropositive patients, we analyzed the data of 349 seropositive patients who received UCBT in Korea between 2000 and 2011. CMV reactivation occurred in 49 % (171/349) of the CMV-seropositive transplant recipients at a median of 31 days post UCBT. One hundred sixty-four
out of 171 patients (96 %) received preemptive therapy. The median duration of CMV reactivation was 29 days. In multivariate analysis, weight >22 kg, use of total body irradiation, use of pre-transplant antithymocyte globulin, graft-versushost disease (GVHD) prophylaxis with mycophenolate mofetil, and presence of grade II–IV acute GVHD were independent predictors of CMV reactivation. CMV reactivation did
M. Park Department of Pediatrics, College of Medicine, Chungbuk National University, Cheongju, South Korea
H. J. Baek : H. Kook : T. J. Hwang Department of Pediatrics, Chonnam National University Hwasun Hospital, Medical School, Chonnam National University, Gwangju, South Korea
Y. H. Lee (*) Department of Pediatrics, Hanyang University Medical Center, College of Medicine, Hanyang University, 222 Wangsimni-ro, Seongdong-gu Seoul 133-792, South Korea e-mail:
[email protected] S. H. Lee : K. H. Yoo : K. W. Sung : H. H. Koo Department of Pediatrics, Samsung Medical Center, School of Medicine, Sungkyunkwan University, Seoul, South Korea J. W. Lee : H. J. Kang : K. D. Park : H. Y. Shin : H. S. Ahn Department of Pediatrics, Cancer Research Institute, College of Medicine, Seoul National University, Seoul, South Korea
J. M. Lee : J. O. Hah Department of Pediatrics, College of Medicine, Yeungnam University, Daegu, South Korea Y. J. Lim Department of Pediatrics, Chungnam National University, Daejon, South Korea J. E. Park Department of Pediatrics, School of Medicine, Ajou University, Suwon, South Korea C. J. Lyu Department of Pediatrics, College of Medicine, Yonsei University, Seoul, South Korea
J. W. Lee : N.6.9 years, weight >22 kg, use of total body irradiation (TBI), pretransplant ATG, GVHD prophylaxis with mycophenolate mofetil (MMF), presence of PES, and grade II–IV acute GVHD. In multivariate analysis, weight >22 kg, TBI, pre-transplant ATG, GVHD prophylaxis with MMF, and presence of grade II–IV acute GVHD remained independent predictors of CMV reactivation. Impact of CMV reactivation on transplantation-related outcomes Engraftment data were available for 168 out of the 171 patients with CMV reactivation. Neutrophil engraftment occurred in 153 of these 168 patients, and the median time to engraftment was 18 days (range, 7–58 days). The cumulative incidence of neutrophil engraftment at 60 days after UCBT was significantly higher in patients experiencing CMV reactivation than in those not experiencing reactivation (90.6 vs. 77.0 %, p
