Vaccine and Infectious Disease Division

Improving prevention of CMV disease in high-risk umbilical blood transplant recipients

Umbilical cord blood transplants offer transplants and cures to many of the 16,000 leukemia patients each year who are unable to find a matching bone marrow donor, but pose unique complications due to the small number of blood stem cells present in each donated umbilical cord. Cord blood transplant recipients are at increased risk for infections due to a significant delay in the reconstitution of their immune systems. In particular, recipients who are seropositive for cytomegalovirus (CMV) have a high likelihood of CMV reactivation and are less able to control replication than recipients of other types of hematopoietic stem cell transplants. High viral loads are also associated with development of viral invasion and poor clinical outcomes.

In an effort to improve outcomes in CMV seropositive cord blood transplant recipients at the Seattle Cancer Care Alliance, CRD research associate Dr. Filippo Milano and colleagues, including VIDD assistant member Dr. Steven Pergam, VIDD member Dr. Michael Boeckh and CRD member Dr. Colleen Delaney, instituted an intensive strategy to prevent or reduce CMV disease in seropositive transplant recipients and compared outcomes using this new strategy with outcomes from the Center’s standard treatment regimen. This new strategy included high-dose administration of antiviral medicines before and after transplantation and biweekly monitoring for CMV in the bloodstream for preemptive therapy as needed.  This new strategy significantly reduced the risk of CMV reactivation and led to fewer cases of CMV disease in high-risk CMV seropositive cord blood transplant recipients. Additionally, patients on the new strategy who had CMV reactivation were on CMV-specific antiviral therapy for significantly fewer days than prior patients, demonstrating the benefit of intensive monitoring for reactivation episodes. Overall, this intensive CMV prevention strategy showed great benefit for CMV seropositive cord blood transplant recipients; a multicenter study is now in planning to confirm and extend the results.

Milano F, Pergam SA, Xie H, Leisenring WM, Gutman JA, Riffkin I, Chow V, Boeckh MJ, Delaney C. Intensive strategy to prevent CMV disease in seropositive umbilical cord blood transplant recipients. Blood. 2011 Nov 17;118(20):5689-96.