The risk of early and late CMV DNAemia associated with Campath use in stem cell transplant recipients

The risks associated with in vivo and ex vivo use of Campath-1H and -1G in a cohort of 206 stem cell transplant recipients for human CMV (HCMV) DNAemia have been quantified. DNAemia showed a biphasic incidence pattern with an inflexion at day 60. The first phase had a linear risk rate for HCMV DNAem...

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Bibliographic Details
Published in:	Bone marrow transplantation (Basingstoke) Vol. 45; no. 7; pp. 1212 - 1219
Main Authors:	Buyck, H C, Prentice, H G F, Griffiths, P D, Emery, V C
Format:	Journal Article
Language:	English
Published:	London Nature Publishing Group UK 01-07-2010 Nature Publishing Group
Subjects:	Adolescent Adult Alemtuzumab Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Antibodies, Monoclonal - adverse effects Antibodies, Monoclonal, Humanized Antibodies, Neoplasm - adverse effects Antineoplastic Agents Biological and medical sciences Bone marrow Bone marrow, stem cells transplantation. Graft versus host reaction CD34 antigen Cell Biology Child Child, Preschool Cohort Studies Cytomegalovirus - isolation & purification Cytomegalovirus infections Cytomegalovirus Infections - chemically induced DNA, Viral - blood Drug therapy Female Genetic aspects Graft-versus-host reaction Health aspects Hematology Hematopoietic Stem Cell Transplantation - adverse effects Hematopoietic Stem Cell Transplantation - methods Humans Immune response In Vitro Techniques Internal Medicine Medical sciences Medicine Medicine & Public Health Middle Aged Multivariate Analysis original-article Public Health Radiation therapy Retrospective Studies Risk Risk analysis Risk Factors Stem cell transplantation Stem Cells Time Factors Transfusions. Complications. Transfusion reactions. Cell and gene therapy Transplantation Young Adult United Kingdom replication kinetics CMV disease immune response Antineoplastic agent Cytomegalovirus Late Immune response Hematology Herpesviridae Stem cell Hematopoietic cell Recipient Alemtuzumab Monoclonal antibody Betaherpesvirinae Virus Immunomodulator Risk factor Graft Early Replication Kinetics Immunosuppressive agent
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Summary:	The risks associated with in vivo and ex vivo use of Campath-1H and -1G in a cohort of 206 stem cell transplant recipients for human CMV (HCMV) DNAemia have been quantified. DNAemia showed a biphasic incidence pattern with an inflexion at day 60. The first phase had a linear risk rate for HCMV DNAemia of 0.3% per day, whereas the second phase had a substantially lower risk rate of 0.058% per day. In multivariable analyses, risk factors for early DNAemia were HCMV serostatus, radiotherapy-based conditioning and CD34 stem cell dose, with the use of in vivo Campath-1H having the most significant risk (hazards ratio=3.68; 95% CI=2.02–6.72; P <0.001). Ex vivo use of Campath was not associated with an increased risk for HCMV DNAemia. Patients receiving either in vivo Campath-1H or -1G experienced HCMV DNAemia earlier (27 and 33 days, respectively) compared with patients receiving no Campath (time to DNAemia, 51 days; P =0.0006). Multivariable analysis of risk factors for HCMV DNAemia occurring beyond 100 days after transplant were older age, acute GVHD>grade II and a lower CD34 stem cell dose, whereas Campath-1H use was not associated with late HCMV DNAemia.
ISSN:	0268-3369 1476-5365
DOI:	10.1038/bmt.2009.329