CYTOMEGALOVIRUS INFECTION AFTER STEM CELL TRANSPLANTATION: COMPARISON BETWEEN BONE MARROW TRANSPLANTATION AND CORD BLOOD TRANSPLANTATION

Abstract

Cytomegalovirus (CMV) infection is one of the most dangerous complications of allogeneic stem cell transplantation. We compared the incidence of CMV infection after cord blood transplantation (CBT) to that after bone marrow transplantation (BMT) . CMV-positive antigenemia was observed in 5 (27.8%) of 18 patients after BMT and in 9 (56.3%) of 16 patients after CBT. In cases involving steroid therapy, the rate of CM V-positive antigenemia rose in both groups. Because the recovery of CM V-specific T cell responses plays an important role in the prevention of CMV disease after stem cell transplantation, it is thought that the recovery of CMV-specific T cells is delayed by the administration of steroids. Moreover, among patients not receiving steroid therapy, the rate of CMV-positive antigenemia was higher after CBT than after BMT. Thus, the immunologic immaturity of cord blood lymphocytes may be associated with delayed recovery of CMV-specific immunity after CBT. Only one patient in the CBT group developed CMV disease after pre-emptive ganciclovir therapy. It appears that preemptive ganciclovir therapy is very effective against CMV infection after CBT.