Elsevier

Transplantation Proceedings

Volume 41, Issue 9, November 2009, Pages 3859-3862
Transplantation Proceedings

Bone marrow and stem cell transplantation
Relationship Between HLA Tissue Type, CMV Infection, and Acute Graft-vs-Host Disease After Allogeneic Hematopoietic Stem Cell Transplantation: Single-Center Experience

https://doi.org/10.1016/j.transproceed.2009.04.017Get rights and content

Abstract

After allogeneic hematopoietic stem cell transplantation, risk factors for cytomegalovirus (CMV) reactivation include pretransplantation donor and recipient CMV serologic status and posttransplantation development of acute graft-vs-host disease (aGvHD). Human leukocyte antigen (HLA) allele type is an additional factor in CMV infection. The present study included 108 patients who received an allogeneic stem cell graft from an HLA-identical sibling between 1993 and 2004. All recipients and donors were typed for HLA-A, HLA-B, and HLA-DR alleles using serologic or molecular methods. All recipients received grafts because of a hematologic disease from HLA full-matched donors. In pretransplantation seropositive patients with aGvHD, no significant difference was observed in patients who developed CMV infection compared with those without CMV infection. Seropositive patients without aGvHD but with posttransplantation CMV infection demonstrated a higher incidence of HLA-A30, HLA-B40, and HLA-DRB1*15 compared with those without CMV infection. In conclusion, it seems that certain HLA alleles may have either a protective or predisposing role in CMV reactivation, which might be helpful in estimating the risk of aGvHD and designing individualized therapy.

Section snippets

Patients and Methods

We retrospectively analyzed 108 consecutive allogeneic BMT recipients for CMV infection. All patients had a hematologic disease and received transplants from HLA full-matched donors between 1995 and 2004 in the same adult BMT unit. Patient and donor characteristics are given in Table 1. The most frequently used conditioning regimen was myeloablative doses of cyclophosphamide combined with busulfan or total-body irradiation. Prophylaxis for aGvHD usually included cyclosporine and short-term

Results

Except for 3 individuals, all donors were relatives (sibling, n = 102; relative, n = 3). All but 3 recipients were CMV seropositive at transplantation (n = 105), and 103 received a graft from a CMV seropositive donor. CMV infection or disease developed in 15 of 108 patients (14%). In 5 patients, CMV disease was included in the differential diagnosis.

Acute GvHD with grade II to IV severity developed in 33 of 108 patients (31%), and all of these patients were CMV seropositive before BMT.

Discussion

Acute GvHD, a reaction of donor immune cells against host tissues, occurs after allogeneic hemopoietic stem cell transplantation (HSCT). Activated donor T cells damage host epithelial cells after an inflammatory cascade that begins with the conditioning regimen. Approximately 35% to 50% of HSCT recipients will develop aGvHD. The exact risk depends on the stem cell source, age of the patient, conditioning regimen, and GvHD prophylaxis therapy.3 Using multivariate analysis, Hägglund et al4 found

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