CMV is a common virus in the general population. Indeed, more than 90% of adults are carriers. In healthy people, CMV infection usually goes unnoticed, although the virus remains with them in latency throughout their lives. However, in leukemia patients receiving bone marrow transplants, CMV infection increases the risk of death. Yet, reactivation of CMV after a transplant is quickly detected and easily treated by current antiviral drugs. “Deaths due to uncontrolled CMV reactivation are virtually zero in this study, so uncontrolled CMV reactivation is not what reduces survival rates after transplantation. The link between this common virus and increased risk of death remains a biological mystery,” said Dr. Teira.
One possible explanation is that CMV decreases the ability of the transplant patient’s immune system to fight against other types of infection. This is supported by the fact that death rates from infections other than CMV are higher in patients infected with CMV, or whose donors were. For researchers, the next step is therefore to verify whether the latest generation of anti-CMV treatments can prevent both reactivation of the virus and weakening of the patient's immune system against other types of infection in the presence of CMV infection. “CMV has a complex impact on the outcomes for transplant patients, and each year more than 30,000 patients around the world receive bone marrow transplants from donors. It is therefore essential for future research to better understand the role played by CMV after bone marrow transplantation and improve the chances of success of the transplant. This will help to better choose the right donor for the right patient," concluded Dr. Teira.
Bone marrow transplantationBone marrow transplantation is used as a treatment in leukemia patients when other types of therapy have failed. It involves injecting the patient with healthy blood stem cells from the bone marrow of a compatible donor to allow the "good" blood cells to multiply and replace the diseased cells, and to rebuild the immune system to fight against the disease and prevent infections.
About the studyThe article "Early cytomegalovirus reactivation remains associated with increased transplant related mortality in the current era: a CIBMTR analysis” was published online in the journal Blood. The study was conducted using the Center for International Blood and Marrow Transplant Registry (CIBMTR), which collects all data relating to patients and their donors for transplants performed in more than 400 hospitals worldwide. Dr. Pierre Teira is hematologist-oncologist at the CHU Sainte-Justine and assistant clinical professor at the University of Montreal's Faculty of Medicine. The study was funded by the U.S. National Institutes of Health and the U.S. Health Resources and Services Administration, which support the CIBMTR.
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Blood, May 2016; U.S. National Institutes of Health and the U.S. Health Resources and Services Administration