A review of cytomegalovirus infections following nonmyeloablative allogeneic stem cell transplants using Campath-1H
Year: 2004
Type: article
Abstract: The first cytomegalovirus (CMV) strain was isolated in cell cultures in 1956. Since that time, there have been many studies showing that CMV is one of the most common and potentially life threatening viral infections in immunosuppressed patients. CMV disease leads to increased morbidity and mortality rates in bone marrow transplant patients. Thanks to advancing technology, testing for CMV on the DNA level has enabled us to assess viral loads and CMV reactivation prior to the onset of CMV disease. The availability of new antiviral medications has also enabled us to initiate preemptive antiviral therapy when CMV DNA is first detected. This early detection and treatment has led to a decrease in end-organ CMV disease and overall mortality from CMV related infections. Nonmyeloablative stem cell transplantation is a less toxic approach to allogeneic transplants. Using chemotherapy regimens with less acute toxicity provide the benefits of allogeneic stem cells and graft versus malignancy effect to patients who may not otherwise tolerate a full myeloablative chemotherapy regimen. This poster will review the incidence and time of onset of CMV viremia in 125 adult patients participating in a clinical trial using a nonmyeloablative preparative regimen of 2 grams Cyclophosphamide and Fludarabine along with Campath-1H for T-cell depletion of the patient and their donor. This regimen was followed by allogeneic peripheral stem cell transplant from a matched or mismatched donor. Developing a standard for antiviral prophylaxis post allogeneic stem cell transplantation provides a unique challange to our health care team and is an area that needs further research in all transplant centers. The first cytomegalovirus (CMV) strain was isolated in cell cultures in 1956. Since that time, there have been many studies showing that CMV is one of the most common and potentially life threatening viral infections in immunosuppressed patients. CMV disease leads to increased morbidity and mortality rates in bone marrow transplant patients. Thanks to advancing technology, testing for CMV on the DNA level has enabled us to assess viral loads and CMV reactivation prior to the onset of CMV disease. The availability of new antiviral medications has also enabled us to initiate preemptive antiviral therapy when CMV DNA is first detected. This early detection and treatment has led to a decrease in end-organ CMV disease and overall mortality from CMV related infections. Nonmyeloablative stem cell transplantation is a less toxic approach to allogeneic transplants. Using chemotherapy regimens with less acute toxicity provide the benefits of allogeneic stem cells and graft versus malignancy effect to patients who may not otherwise tolerate a full myeloablative chemotherapy regimen. This poster will review the incidence and time of onset of CMV viremia in 125 adult patients participating in a clinical trial using a nonmyeloablative preparative regimen of 2 grams Cyclophosphamide and Fludarabine along with Campath-1H for T-cell depletion of the patient and their donor. This regimen was followed by allogeneic peripheral stem cell transplant from a matched or mismatched donor. Developing a standard for antiviral prophylaxis post allogeneic stem cell transplantation provides a unique challange to our health care team and is an area that needs further research in all transplant centers.
Authors: M. Thompson, C. Catlin, D. Rizzieri
Institution: Duke Medical Center
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $3,650
OpenAlex ID: W1971033699