Impact of cytomegalovirus (CMV) reactivation after umbilical cord blood transplantation.

Abstract

This study investigated the impact of pre-transplant CMV serostatus and posttransplant CMV reactivation and disease on umbilical cord blood transplant (UCBT) outcomes. Between 1994 and 2007, 332 patients with hematologic malignancies underwent UCBT and 54% were CMV seropositive. Pre-transplant recipient CMV serostatus had no impact on acute or chronic GVHD, relapse, disease free survival (DFS), or overall survival (OS). There was a trend toward greater day 100 treatment-related mortality (TRM) in CMV seropositive recipients (p=0.07). CMV reactivation occurred in 51% (92/180) of patients with no difference in myeloablative (MA) versus reducedintensity conditioning (RIC) recipients (p=0.33). Similarly, reactivation was not influenced by the number of UCB units transplanted, the degree of HLA disparity, the CD34+ or CD3+ cell dose, or donor killer immunoglobulin-like receptor (KIR) gene haplotype. Rapid lymphocyte recovery was associated with CMV reactivation (p=0.02). CMV reactivation was not associated with acute (p=0.97) or chronic GVHD (p=0.65), nor did it impact TRM (p=0.88), relapse (p=0.62) or survival (p=0.78). CMV disease occurred in 13.8% of the CMV-seropositive patients, resulting in higher TRM (p=0.01)and lower OS (p=0.02). Thus, although recipient CMV serostatus and CMV reactivation have little demonstrable impact on UCB transplant outcomes, the development of CMV disease remains a risk, associated with inferior outcomes.