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Viral Infections

Pre-emptive treatment of CMV DNAemia in paediatric stem cell transplantation: the impact of recipient and donor CMV serostatus on the incidence of CMV disease and CMV-related mortality

Bone Marrow Transplantation volume 31, pages 803–808 (2003)Cite this article

Summary:

Cytomegalovirus (CMV) DNAemia was detected by PCR in 30/125 (24%) consecutive paediatric patients undergoing allogeneic stem cell transplantation. All patients with CMV DNAemia received pre-emptive ganciclovir until two consecutive negative results were obtained. CMV-IgG-positive patients (R+) had a significantly increased risk of DNAemia as compared to CMV-IgG-negative (R−) patients (62% vs 8%) P<0.0001. The incidence of DNAemia was 71% (10/14) in R+ transplanted from seronegative donors (D−) compared to 54% (13/32) in those transplanted from seropositive donors (D+). Of 30 (40%) children with DNAemia, 12 developed CMV disease despite pre-emptive treatment. The overall incidence of disease was 0% (0/59) for R−/D−, 9% (3/23) for R+/D+, 7% (2/29) for R−/D+ and 57% (8/14) for R+/D−. In patients with DNAemia, 4/20 (20%) patients with D+ and 8/10 (80%) with D− became symptomatic. In the multivariate analysis of both groups, patients at risk (R+ and/or D+) and patients with DNAemia, a negative donor serostatus was the only factor associated with a significantly increased incidence of disease. Seven of 9 patients with lethal CMV disease had received CMV-IgG-negative grafts. The data suggest that in CMV seropositive recipients donor CMV seropositivity is associated with a reduced incidence of CMV disease and a favourable outcome following pre-emptive treatment.

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Authors and Affiliations

  1. St. Anna Children's Hospital, Vienna, Austria

    S Matthes-Martin, A Lawitschka & C Peters

  2. Children's Cancer Research Institute, Vienna, Austria

    T Lion, G Fritsch & H Gadner

  3. Institute of Virology, University of Vienna, Vienna, Austria

    S W Aberle

  4. Department of Medical Statistics, University of Vienna, Vienna, Austria

    B Bittner & F Frommlet

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  1. S Matthes-Martin
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  2. T Lion
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  3. S W Aberle
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  4. G Fritsch
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  5. A Lawitschka
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Matthes-Martin, S., Lion, T., Aberle, S. et al. Pre-emptive treatment of CMV DNAemia in paediatric stem cell transplantation: the impact of recipient and donor CMV serostatus on the incidence of CMV disease and CMV-related mortality. Bone Marrow Transplant 31, 803–808 (2003). https://doi.org/10.1038/sj.bmt.1703927

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