Table 1.
Epidemiologic Risk-factors Associated with CMV Disease in Patients Undergoing Hematopoietic Cell Transplantation
| Transplant Associated Risk Factors | Risk | Selected References |
|---|---|---|
|
| ||
| Pre-Transplant Risk Factors | ||
| CMV Serostatus | ||
| CMV R+ Status |
|
3,17,25,152 |
| - if CMV D- Donor Status |
|
21,22,153 |
| CMV R-/D+ |
|
20,24 |
| Donor Graft | ||
| PBMC vs. Bone Marrow | ⇩ | 26 |
| Umbilical Cord Blood |
|
6,19,27,28 |
| Unrelated Donor |
|
14,29,32,154 |
| Donor Mismatch |
|
154,155 |
| Conditioning Regimen | ||
| T-cell depletion |
|
15,18,34–37 |
| Myeloablative vs. Non-myeloablative | ⇳ | 4,30,156,157 |
| Post-Transplant Risk Factors | ||
| CMV detection in Blood* |
|
multiple |
| High initial viral load |
|
50,51 |
| Hematologic recovery | ||
| Lymphopenia† |
|
11,12,50 |
| GVHD | ||
| Acute GVHD |
|
41–43,50,158 |
| Chronic GVHD |
|
10,39,159 |
| GVHD prophylaxis and treatment | ||
| Anti-T-cell therapy |
|
3,160 (see above) |
| Use of MMF |
|
45 – 47 |
| Use of Sirolimus | ⇩ | 48 |
| Steroids >1 mg/kg/day |
|
39,158 |
Abbreviations: CMV, Cytomegalovirus; R+, recipient serpositive; D−, Donor seronegative; R−, recipient seronegative; D+, Donor positive; PBMC, peripheral blood mononuclear cells; GVHD, graft-versus-host disease; MMF, mycophenolate mofetil. Strength of association demonstrated by the number of arrows:
indicates increased rate; ⇩indicates decreased rate; ⇳ indicates conflicting data.
*
Detection in blood increases the risk for the development for both early and late CMV disease.
†
Likely related to all lymphocyte subsets, but CD4 and CD8 probably most important.