Biol Blood Marrow Transplant 20 (2014) 593
Letter to the Editor
Evaluation of Potentially Infectious Blood Donors in Cases of Presumed Transfusion-Transmitted Cytomegalovirus Infections
ASBMT
American Society for Blood and Marrow Transplantation
Malte Ziemann*, Holger Hennig Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
Article history: Received 30 December 2013 Accepted 30 December 2013
In the December issue, Kekre et al. [1] provided very interesting data about the incidence of cytomegalovirus (CMV) infections in patients with allogeneic stem cell transplantation. In contrast to 2 other reports [2,3], active CMV infections and even CMV disease were detected in this study. Comparing the classic transfusion strategy of leukoreduced and CMV-seronegative blood units with the current approach of only leukoreduced but CMV-untested units, there was no significant difference in the incidence of CMV viremia or CMV disease. The authors assume that all 4 CMV infections in the study period were transfusion related and presumably caused by seronegative donors in the window phase of their primary CMV infection. To support this hypothesis, a publication of our group [4] is cited to report window periods being as long as months. Because only 1 seronegative sample of each donor was analyzed in the cited study, no conclusions about the duration of the window period can be drawn from these data. In other studies we were able to show that window period donations are rare and contain less CMV DNA than donations from primarily seropositive donors [5,6]. Donors in the early seropositive phase of their primary CMV infection were also responsible for higher peak CMV DNA concentrations in CMV-untested donations compared with CMV-seronegative donations in a study of almost 23,000 donations [7]. Nevertheless, seronegative blood products containing CMV might be more infectious than units from seropositive donors with potentially neutralizing antibodies.
To further strengthen the hypothesis of transfusiontransmitted CMV infections, it would be interesting to determine how many donors, who donated blood products for the patients with CMV infection, later developed CMV antibodies. Ideally, the number of seroconverted donors is greater for patients with CMV infection than for other patients. If stored serum samples were still available from these donors, they could also be tested for CMV DNA.
REFERENCES 1. Kekre N, Tokessy M, Mallick R, et al. Is cytomegalovirus testing of blood products still needed for hematopoietic stem cell transplant recipients in the era of universal leukoreduction? Biol Blood Marrow Transplant. 2013; 19:1719-1724. 2. Thiele T, Krüger W, Zimmermann K, et al. Transmission of cytomegalovirus (CMV) infection by leukoreduced blood products not tested for CMV antibodies: a single-center prospective study in high-risk patients undergoing allogeneic hematopoietic stem cell transplantation (CME). Transfusion. 2011;51:2620-2626. 3. Nash T, Hoffmann S, Butch S, et al. Safety of leukoreduced, cytomegalovirus (CMV)-untested components in CMV-negative allogeneic human progenitor cell transplant recipients. Transfusion. 2012;52: 2270-2272. 4. Ziemann M, Unmack A, Steppat D, et al. The natural course of primary cytomegalovirus infection in blood donors. Vox Sang. 2010;99:24-33. 5. Ziemann M, Krueger S, Maier AB, et al. High prevalence of cytomegalovirus DNA in plasma samples of blood donors in connection with seroconversion. Transfusion. 2007;47:1972-1983. 6. Ziemann M, Heuft H-G, Frank K, et al. Window period donations during primary cytomegalovirus infection and risk of transfusion-transmitted infections. Transfusion. 2013;53:1088-1094. 7. Ziemann M, Juhl D, Görg S, Hennig H. The impact of donor cytomegalovirus DNA on transfusion strategies for at-risk patients. Transfusion. 2013;53:2183-2189.
* Correspondence and reprint requests: Malte Ziemann, MD, Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail address: [email protected] (M. Ziemann). 1083-8791/$ e see front matter Ó 2014 American Society for Blood and Marrow Transplantation. http://dx.doi.org/10.1016/j.bbmt.2013.12.572
Letter to the Editor
Evaluation of Potentially Infectious Blood Donors in Cases of Presumed Transfusion-Transmitted Cytomegalovirus Infections
ASBMT
American Society for Blood and Marrow Transplantation
Malte Ziemann*, Holger Hennig Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Lübeck, Germany
Article history: Received 30 December 2013 Accepted 30 December 2013
In the December issue, Kekre et al. [1] provided very interesting data about the incidence of cytomegalovirus (CMV) infections in patients with allogeneic stem cell transplantation. In contrast to 2 other reports [2,3], active CMV infections and even CMV disease were detected in this study. Comparing the classic transfusion strategy of leukoreduced and CMV-seronegative blood units with the current approach of only leukoreduced but CMV-untested units, there was no significant difference in the incidence of CMV viremia or CMV disease. The authors assume that all 4 CMV infections in the study period were transfusion related and presumably caused by seronegative donors in the window phase of their primary CMV infection. To support this hypothesis, a publication of our group [4] is cited to report window periods being as long as months. Because only 1 seronegative sample of each donor was analyzed in the cited study, no conclusions about the duration of the window period can be drawn from these data. In other studies we were able to show that window period donations are rare and contain less CMV DNA than donations from primarily seropositive donors [5,6]. Donors in the early seropositive phase of their primary CMV infection were also responsible for higher peak CMV DNA concentrations in CMV-untested donations compared with CMV-seronegative donations in a study of almost 23,000 donations [7]. Nevertheless, seronegative blood products containing CMV might be more infectious than units from seropositive donors with potentially neutralizing antibodies.
To further strengthen the hypothesis of transfusiontransmitted CMV infections, it would be interesting to determine how many donors, who donated blood products for the patients with CMV infection, later developed CMV antibodies. Ideally, the number of seroconverted donors is greater for patients with CMV infection than for other patients. If stored serum samples were still available from these donors, they could also be tested for CMV DNA.
REFERENCES 1. Kekre N, Tokessy M, Mallick R, et al. Is cytomegalovirus testing of blood products still needed for hematopoietic stem cell transplant recipients in the era of universal leukoreduction? Biol Blood Marrow Transplant. 2013; 19:1719-1724. 2. Thiele T, Krüger W, Zimmermann K, et al. Transmission of cytomegalovirus (CMV) infection by leukoreduced blood products not tested for CMV antibodies: a single-center prospective study in high-risk patients undergoing allogeneic hematopoietic stem cell transplantation (CME). Transfusion. 2011;51:2620-2626. 3. Nash T, Hoffmann S, Butch S, et al. Safety of leukoreduced, cytomegalovirus (CMV)-untested components in CMV-negative allogeneic human progenitor cell transplant recipients. Transfusion. 2012;52: 2270-2272. 4. Ziemann M, Unmack A, Steppat D, et al. The natural course of primary cytomegalovirus infection in blood donors. Vox Sang. 2010;99:24-33. 5. Ziemann M, Krueger S, Maier AB, et al. High prevalence of cytomegalovirus DNA in plasma samples of blood donors in connection with seroconversion. Transfusion. 2007;47:1972-1983. 6. Ziemann M, Heuft H-G, Frank K, et al. Window period donations during primary cytomegalovirus infection and risk of transfusion-transmitted infections. Transfusion. 2013;53:1088-1094. 7. Ziemann M, Juhl D, Görg S, Hennig H. The impact of donor cytomegalovirus DNA on transfusion strategies for at-risk patients. Transfusion. 2013;53:2183-2189.
* Correspondence and reprint requests: Malte Ziemann, MD, Institute of Transfusion Medicine, University Hospital of Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany. E-mail address: [email protected] (M. Ziemann). 1083-8791/$ e see front matter Ó 2014 American Society for Blood and Marrow Transplantation. http://dx.doi.org/10.1016/j.bbmt.2013.12.572
