Active cytomegalovirus infection in autologous stem cell transplant recipients: Incidence and clinical impact

Cytomegalovirus (CMV) infection in patients after autologous stem cell transplant (ASCT) has become a major medical concern. However, few studies have reported active CMV infection before the transplantation. In this study, we retrospectively analyzed the incidence, clinical impact, risk factors, and outcome of CMV pp65 antigenemia in 44 consecutive patients who underwent ASCT between January 2005 and June 2011. CMV pp65 antigenemia assay was performed weekly, from 7 days before stem cell infusion until the patient was discharged. All patients were CMV seropositive before ASCT. Pre-transplantation antigenemia was detected in 19 patients (43.2%) and post-transplantation antigenemia in 17 patients (38.6%). Multivariate analysis could not identify any pre-transplantation risk factors for CMV antigenemia. When patients with and without pre-transplantation antigenemia were compared, we found that pre-transplantation active CMV infection had significant effects on post-transplantation platelet and neutrophil recovery, although the time of hospitalization and amount of blood transfusion were similar in both groups. CMV antigenemia was asymptomatic in all cases, and cleared spontaneously in 86.7% of patients who did not receive antiviral treatment. In conclusion, CMV reactivation before ASCT might occur frequently and even an asymptomatic infection could significantly delay engraftment. Therefore, ASCT candidates should be routinely evaluated for active CMV infection.