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Updated: Sep 25, 2026
Generation of Multivirus-specific T Cells to Prevent/treat Viral Infections after Allogeneic Hematopoietic Stem Cell Transplant
Published on: May 27, 2011
Extended antigenemia surveillance and late cytomegalovirus infection after allogeneic BMT
C M Machado1, R X Menezes, M C Macedo
1Virology Laboratory (LIM 52-HCFMUSP) of Instituto de Medicina Tropical de São Paulo, São Paulo, Brazil.
Abstract:
Late CMV disease remains a major concern in allogeneic BMT recipients. Few surveillance data are available on the occurrence of CMV infection and recurrences after day +100. We evaluated the occurrence of antigenemia (AG) recurrences until day +365 in 76 patients who received pre-emptive ganciclovir (GCV) therapy prompted by AG > or = 2 positive cells. Sixty-two episodes of AG recurrences were detected in 33 of the 52 patients who had positive AG. Survival analysis showed a 45.4% probability of AG recurrence on day +100, 64.8% on day +180 and 71.2% on day +365. The median time for AG recurrences was 113 (35 to 343) days. Thirty-five of the 62 episodes (56.4%) occurred after day +100. More than 70% of the patients responded to a 2-week course of GCV and no CMV disease was observed shortly after discontinuation of GCV. The Cox proportional model showed a significant effect of AG recurrences on patient's follow-up only when the patient developed chronic GVHD (P = 0.012). Extended surveillance favored early introduction of GCV and late CMV pneumonia occurred in only one of the 76 patients (1.3%). AG recurrences are frequent after day +100 and extended surveillance until day +365 is recommended for patients who develop chronic GvHD.
Insights
Late Cytomegalovirus (CMV) antigenemia recurrences are common after 100 days in allogeneic bone marrow transplant (BMT) recipients. Extended surveillance and early ganciclovir (GCV) therapy are recommended, especially for those with chronic GVHD.
Area of Science:
- Hematology
- Infectious Diseases
- Transplantation Immunology
Background:
- Late Cytomegalovirus (CMV) disease is a significant complication in allogeneic bone marrow transplant (BMT) recipients.
- Limited data exist on CMV infection and recurrence patterns beyond day +100 post-transplant.
Purpose of the Study:
- To evaluate the occurrence of CMV antigenemia (AG) recurrences until day +365 in allogeneic BMT patients.
- To assess the efficacy of pre-emptive ganciclovir (GCV) therapy for late CMV recurrences.
- To identify risk factors and outcomes associated with late CMV AG recurrences.
Main Methods:
- Prospective evaluation of 76 allogeneic BMT recipients receiving pre-emptive ganciclovir (GCV) therapy for CMV antigenemia (AG) ≥ 2 positive cells.
- Survival analysis to determine the probability and timing of AG recurrences up to day +365.
- Cox proportional hazards model to analyze the impact of AG recurrences and chronic GVHD on patient outcomes.
Main Results:
- Sixty-two episodes of CMV AG recurrences were detected in 33 patients, with 56.4% occurring after day +100.
- The probability of AG recurrence reached 71.2% by day +365, with a median recurrence time of 113 days.
- Over 70% of patients responded to GCV, and only one patient developed CMV pneumonia (1.3%).
- Chronic GVHD was a significant factor associated with AG recurrences (P = 0.012).
Conclusions:
- CMV antigenemia recurrences are frequent after day +100 in allogeneic BMT recipients.
- Extended surveillance until day +365 and early GCV introduction are recommended, particularly for patients with chronic GVHD.
- Pre-emptive GCV therapy appears effective in managing late CMV recurrences and preventing CMV disease.
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