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Post-Transplant Events

Cytomegalovirus (CMV) infections and CMV-specific cellular immune reconstitution following reduced intensity conditioning allogeneic stem cell transplantation with Alemtuzumab

Bone Marrow Transplantation volume 36, pages 797–802 (2005)Cite this article

Summary:

We studied the incidence and recurrence of Cytomegalovirus (CMV) infection and reactivation in 38 recipients of Alemtuzumab reduced intensity conditioning-stem cell transplantation, and used CMV-HLA tetramer studies to discover if these events correlated with recovery of circulating CMV-specific CD8+ T cells (cytotoxic T lymphocyte (CTLs)). The cumulative incidence of CMV infection was 60% at 1 year (95% CI, 45–78%) with a median reactivation time of 24 days (range 5–95 days). All patients with CMV reactivation received Ganciclovir or Foscarnet, and only one developed CMV disease. More strikingly, only 8/21 patients had relapse of CMV antigenemia. Tetramer analysis in 13 patients showed that 11 reconstituted CMV CTLs (7/11 by day 30 and 10/11 by day 90). The development of CMV infection was accompanied by a >5-fold rise of CMV CTLs. Recurrence of CMV infection occurred only in the patients who failed to generate a CTL response to the virus. Hence, recipients of SCT using Alemtuzumab-RIC are initially profoundly immunosuppressed and have a high incidence of early CMV reactivation. However, in the majority of patients, infection is transient, and antiviral T cell reconstitution is rapid. Monitoring with CMV-specific CTLs may help identify the subset of patients at risk from recurrent infection or disease.

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Acknowledgements

The Amy Strelzer Manasevit Scholar Award.

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Authors and Affiliations

  1. Department of Medicine, Baylor College of Medicine and The Methodist Hospital, Houston, TX, USA

    R Lamba, G Carrum, R A Krance, H E Heslop, M K Brenner & U Popat

  2. Center for Gene and Cell Therapy, Baylor College of Medicine and The Methodist Hospital, Houston, TX, USA

    R Lamba, G Carrum, G D Myers, C M Bollard, R A Krance, H E Heslop, M K Brenner & U Popat

  3. Department of Pediatrics, Baylor College of Medicine and The Methodist Hospital, Houston, TX, USA

    G D Myers, C M Bollard, R A Krance, H E Heslop & M K Brenner

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  1. R Lamba
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  2. G Carrum
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Correspondence to R Lamba.

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Lamba, R., Carrum, G., Myers, G. et al. Cytomegalovirus (CMV) infections and CMV-specific cellular immune reconstitution following reduced intensity conditioning allogeneic stem cell transplantation with Alemtuzumab. Bone Marrow Transplant 36, 797–802 (2005). https://doi.org/10.1038/sj.bmt.1705121

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