Hematopoietic Stem Cell Transplant: Infection Control - Episode 1
Robert J. Soiffer, MD: I’m Robert Soiffer, from Hematologic Malignancies at Dana-Farber Cancer Institute in Boston.
Genovefa Papanicolaou, MD: I’m Genovefa Papanicolaou. I am an infectious disease specialist at Memorial Sloan Kettering Cancer Center in New York and a professor of medicine at Weill Cornell Medical College.
Robert J. Soiffer, MD: We’re going to be talking today about cytomegalovirus infection in recipients of hematopoietic stem cell transplants. I’m going to be asking Genovefa a few questions here about the issue of CMV in patients undergoing transplantation. First, Genovefa, I’m sure it’s a big problem for a number of our patients. Can you describe the types of patients who are particularly susceptible to contracting CMV?
Genovefa Papanicolaou, MD: Approximately 50% of the patients that come for transplant are CMV-seropositive. That means that they have had previous infection with CMV. CMV is the most important and the most common viral infection of their transplant. About half of the CMV-seropositive patients will develop CMV infection after transplant. This infection requires treatment with antiviral medications, and there are a lot of side effects related to the currently available antivirals.
Robert J. Soiffer, MD: Is there a particular type of transplant patient who’s more susceptible to CMV reactivation?
Genovefa Papanicolaou, MD: A number of factors influence the risk for CMV infection. Usually, the degree of mismatch shows recipients that get grafts from mismatched donors, cord blood transplants, and T-cell—depleted transplants. And patients that eventually develop graft-versus-host disease are at greater risk for CMV infection.
Robert J. Soiffer, MD: What types of organs does CMV affect?
Genovefa Papanicolaou, MD: Well, these days, CMV is presented as viremia. We have very sensitive molecular methods of PCR (polymerase chain reaction) to monitor patients from very early after transplant to see if there is CMV replication in the blood. The most common CMV event that we see is CMV viremia. If the viremia is not treated, CMV eventually affects many organs. A common organ is the lungs. Usually, CMV pneumonitis carries a very high fatality rate. The other most common organ is the gastrointestinal tract. So, CMV colitis.
Robert J. Soiffer, MD: How do we monitor patients for CMV? How do we know if they’re about to get a CMV infection?
Genovefa Papanicolaou, MD: At my institution, we start monitoring with PCR about 2 weeks after transplant, and we monitor it regularly. Initially, we monitor the high-risk patients twice a week, and the lower-risk patients at least once a week. We do this monitoring until day 100, more or less. For patients that continue to be at risk for CMV, we continue monitoring until 6 months after transplant, and even until 1 year after transplant, until we believe that they are no longer at risk for CMV.
Transcript edited for clarity.