Autologous Bone Marrow Transplantation - Blog Science Connections

670 Herpesvirus Infections
Table 1. CMV Infections in Patients Receiving Autologous and Allogeneic Bone
Marrow Transplants Over a 9-Year Period at the
Johns Hopkins Oncology Center
Type of Transplant
Infection
Allogeneic
n =386
Autologous
n = 143
Significance
(P value)
Positive culture 119 (31%) 27 (19%) .008
during first 50 days 58 (15%) 23 (16%) NS
Viremia 49 (13%) 7 (5%) .02
during first 50 days 23 (6%) 5 (4%) NS
Retinitis 1 (0.3%) 0 (0%) NS
Pneumonitis 45 (12%) 3 (2%) .0002
Abbreviation: CMV, cytomegalovirus.
lower than that after allogeneic transplantation (12%). The rates of positive
CMV cultures and CMV viremia were lower in autologous transplant recipients
than in allogeneic transplant recipients. The median onset of positive cultures
and viremia were 48 and 49 days, respectively. At our institution, patients who
have received ABMT are routinely followed in our bone marrow transplantation
clinic for only 50 days, rather than the 100 days that are routine after
allogeneic transplantation, because of fewer postengraftment complications
after ABMT. Thus, we examined the infection rate in the first 50 days only, to
exclude a bias in surveillance. During the first 50 days, the infection and
viremia rates were the same in the two types of transplantation.
Despite a high rate of CMV infection in these patients, CMV retinitis was a
rare event, occurring in only one patient (an allogeneic marrow recipient) (4).
This is in marked contrast to the experience with severe CMV infections in
patients with the acquired immune deficiency syndrome, where CMV retinitis
is much more frequent.
A comparable proportion of patients receiving both types of transplants
(67% allogeneic and 70% autologous) were seropositive for CMV prior to
transplantation (Table 2). Of those who were seronegative prior to transplant,
49% of the autologous marrow recipients seroconverted and 46% of the
allogeneic marrow recipients seroconverted after transplant. This indicates
that primary infection with CMV was common, probably because of the use of
contaminated blood products and, in some cases of allogeneic transplantation,
to virus contamination of the marrow. Although the risk for developing
positive CMV cultures appeared to be less after ABMT than after allogeneic
transplantation, irrespective of the pretransplant serology (Table 2), during
the first 50 days the infection rate was similar in patients receiving either type.
Both allogeneic and autologous marrow recipients with positive sera were