Cytomegalovirus Infection in Stem Cell Transplantation

Kim, Seong Cheol; Hahn, Jee Sook; Chong, So Young; Lee, Seok; Yoo, Nae Choon; Min, Yoo Hong; Ko, Yun Woong

Abstract

BACKGROUND: Cytomegalovirus (CMV) infection causes the greatest morbidity and mortality after stem cell transplantation (SCT), and in many western studies, CMV infection develops in approximately 70 to 80% of patients treated with allogeneic bone marrow transplantation (BMT). There have been no reports regarding the prevalence and clinical features of CMV infection and disease in patients receiving SCT in Korea. Therefore, we investigated the frequency and clinical characteristics of CMV infection in 53 cases of SCT.
METHODS
Underlying diseases were acute myelocytic leukemia (n=21), acute lymphocytic leukemia (n=14), chronic myelocytic leukemia (n=4), severe aplastic anemia (n=13) and non- Hodgkin lymphoma (n=1). Pre-transplant serostatus of donors and recipients was all positive for CMV infection. For screening test of CMV detection, CMV antigen assay or shell vial culture was done. CMV infection was defined as CMV antigenemia or recovery of CMV in culture or positive CMV PCR, and CMV disease was diagnosed when patients had symptoms and signs of specific organs with CMV infection.
RESULTS
1) The incidence of CMV infection was 18.9% (10/53) in all transplant recipients. No significant difference of rate of infection and disease between allogeneic BMT and autologous peripheral blood stem cell transplantation was observed. 2) Five of 10 patients with CMV infection had asymptomatic CMV infection, and the other 5 patients developed overt CMV disease. 3) There was no difference of incidence of CMV infection according to age, type of SCT and use of total body irradiation. But, patients with acute graft-versus-host disease (GVHD) had significantly higher incidence of CMV infection than those without acute GVHD in allogeneic BMT (33.3 vs. 7.4%; P=0.04). 4) CMV antigen assay was evaluated as the most sensitive method for the detection of CMV (83.3%), whereas CMV culture showed the lowest sensitivity (37.5%).
CONCLUSIONS
The lower incidence of CMV infection of patients with SCT in our study than that of other western countries may be associated with low incidence of acute GVHD.