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Increased Levels of Tumor Necrosis Factor α Are Associated with an Increased Risk of Cytomegalovirus Infection after Allogeneic Hematopoietic Stem Cell Transplantation

Year: 2005

Type: article

Abstract: Tumor necrosis factor-alpha (TNF) has been implicated in the reactivation of cytomegalovirus (CMV) at a cellular level. We therefore hypothesized that increased posttransplantation TNF levels may be associated with the development of CMV antigenemia (CMV-Ag). We studied 134 patients undergoing allogeneic hematopoietic stem cell transplantation. After excluding CMV-negative donor and recipient pairs, 94 patients were evaluable. By cluster analysis, 2 groups were designated by TNF levels obtained between days 4 and 7 after transplantation: 58 patients had low levels (median, 0 pg/mL; range, 0-5.5 pg/mL), and 36 patients had high levels (median, 43.75 pg/mL; range, 7.5-1756 pg/mL). To determine the independent effect of TNF on the development of CMV-Ag and acute graft-versus-host disease and on survival, Kaplan-Meier and Cox models stratified by TNF patient groups were evaluated. High TNF levels were associated with a more rapid onset of CMV-Ag (P < .001) and with the occurrence of the composite end point of CMV-Ag or death (P < .001). Factors independently associated with CMV-Ag in multivariate analysis were a high TNF level (hazard ratio [HR], 2.57; P = .003) and acute graft-versus-host disease (as a time-dependent covariate; HR, 2.30; P = .010). Factors independently associated with the composite end point of CNV-Ag or death were a high TNF level (HR, 2.42; P < .001) and patient age (per year; HR, 1.93; P = .017). In conclusion, a high posttransplantation TNF level is significantly associated with the risk for developing CMV infection. Early detection of high levels of TNF may be used to identify patients at high risk for developing CMV-Ag.

Source: Transplantation and Cellular Therapy

DOI: 10.1016/j.bbmt.2005.05.013

Authors: Vijay Reddy, Herwig-Ulf Meier-Kriesche, Samantha Greene, Jesse D. Schold, John R. Wingard

Institutions: University of Florida Health, University of Florida

Language: English

Topic: Cytomegalovirus and herpesvirus research

Subfield: Epidemiology

Field: Medicine

Domain: Health Sciences

SDG: Good health and well-being

Open Access status: hybrid

Estimated APC paid: $3,650