High Rates of Passive CMV Antibody Acquisition Pre-Allograft in Patients Receiving Plasma-Rich CMV Unselected and Leukodepleted Blood Components: A Caution for Donor Selection
| العنوان: | High Rates of Passive CMV Antibody Acquisition Pre-Allograft in Patients Receiving Plasma-Rich CMV Unselected and Leukodepleted Blood Components: A Caution for Donor Selection |
|---|---|
| المؤلفون: | Unell Riley, Michael Potter, Mark Ethell, Robert N Lown |
| المصدر: | Blood. 124:1140-1140 |
| بيانات النشر: | American Society of Hematology, 2014. |
| سنة النشر: | 2014 |
| مصطلحات موضوعية: | medicine.medical_specialty, Blood transfusion, biology, business.industry, Donor selection, medicine.medical_treatment, Immunology, virus diseases, Cell Biology, Hematology, Hematopoietic stem cell transplantation, Total body irradiation, Biochemistry, Gastroenterology, Platelet transfusion, Immunoglobulin M, Internal medicine, medicine, biology.protein, Alemtuzumab, Seroconversion, business, medicine.drug |
| الوصف: | For many years there has been ongoing debate in the United Kingdom (UK) about the necessity of using blood components from cytomegalovirus IgG seronegative (CMV neg) donors for CMV neg patients undergoing allogeneic hematopoietic stem cell transplantation, in the era of universal leukodepletion. From June 2012, our centre followed the guidance of the Advisory Committee on the Safety of Blood Tissues and Organs (SaBTO) in the United Kingdom, using CMV unselected leucodepleted components for all patients regardless of CMV serostatus. As part of an ongoing biovigilance commitment, we assessed the impact this policy had on rates of CMV seroconversion and viremia. 137 patients were included in the study, each allografted between March 2012 and December 2013. The median age was 49 years (range 2-71) and 62% were male. Diseases transplanted included acute leukemia or myelodysplastic syndrome (73.0%), lymphoma (11.0%), chronic leukemias (7.3%) and others (8.7%). 42 patients (30.7%) received myeloablative conditioning, 43 (31.4%) received total body irradiation, and 112 (81.7%) received in-vivo T-cell depletion with alemtuzumab. 119 (86.9%) received peripheral blood stem cells, 8 (5.8%) bone marrow, and 10 (7.3%) cord blood. 35 donors (25.5%) were siblings. 78 patients (56.9%) were CMV neg when first documented, of which 62 (79.5%) had a CMV neg donor. 59 patients (43.1%) were CMV IgG seropositive (CMV pos) when first documented, of which 36 (64.3%) had a CMV pos donor. All patients had CMV serology checked again within 28 days pre-transplant: of the 78 CMV neg patients, 14 (17.9%) were found to have changed their CMV status to seropositive. Of note, these patients had received significantly more platelet transfusions in the three months prior to transplant than those who did not seroconvert pre-transplant (median 13 vs 0 adult doses, p Conclusion In 78 CMV IgG negative patients, there were only four incidences of proven primary CMV infection, all in patients receiving CMV pos stem cell donations. Excluding these cases, there were no cases of primary CMV infection associated with transfusion of CMV unselected blood components. However, we found a significant incidence of probable passive transfer of CMV IgG antibody, which was strongly associated with the use of platelet transfusions. Whilst this has no direct impact on the patient, it has significant implications for donor selection if it is incorrectly interpreted as representing prior CMV infection. It is conceivable that a CMV na•ve patient could be incorrectly ascribed as CMV positive due to detectable passive antibody: by selecting a CMV positive donor in these circumstances, the patient is thus subjected to a significant risk of primary CMV infection. Transplant centres must remain vigilant of this possibility, and be aware of the CMV selection policy for blood components in referring hospitals. Pre-transfusion CMV status should be obtained in all potential transplant candidates and, in those who appear to seroconvert, CMV IgM and DNA should be considered as indicators of recent seroconversion. Figure 1 Figure 1. Disclosures No relevant conflicts of interest to declare. |
| تدمد: | 1528-0020 0006-4971 |
| DOI: | 10.1182/blood.v124.21.1140.1140 |
| URL الوصول: | https://explore.openaire.eu/search/publication?articleId=doi_________::10f284bbaf04e50c835c4b6c4b88788a https://doi.org/10.1182/blood.v124.21.1140.1140 |
| رقم الانضمام: | edsair.doi...........10f284bbaf04e50c835c4b6c4b88788a |
| قاعدة البيانات: | OpenAIRE |
| تدمد: | 15280020 00064971 |
|---|---|
| DOI: | 10.1182/blood.v124.21.1140.1140 |