Transfusion-transmission of human cytomegalovirus (TT-CMV) causes serious morbidity and mortality in immunocompromised recipients, including low birth weight infants (LBWI). Yeager and colleagues first demonstrated in 1981 that TT-CMV could be mitigated in high-risk LBWI through exclusive transfusion of CMV seronegative blood components. Nonetheless, since this time, in many parts of the developed world, the de facto clinical standard for transfusion support in this population has evolved to become CMV-seronegative + leukoreduced units. However, the 'CMV-safety' of this approach has never been validated in a large prospective clinical trial. Furthermore, it is not clear whether this represents the optimal transfusion approach for recipients at high risk for CMV transmission, or whether additional safety measures (CMV NAT to identify window-phase units; 100% leukoreduction QC to prevent transfusion of units with failed leukoreduction) are needed to completely prevent TT-CMV. In this prospective multicenter cohort study, we will (Aim 1) closely follow 1300 LBWI (650 each born to CMV-seronegative and -seropositive mothers), rigorously screened to eliminate cases of maternal CMV transmission, in order to calculate accurate point estimates of the risk of TTCMV in this high risk population following uniform receipt of CMV-seronegative + leukoreduced blood. Additionally, aliquots of all transfused components will be screened by high throughput assays for CMV DNA (quantitative) and residual leukocytes (Aim 2). Episodes of documented TT-CMV will be analyzed in the context of transfusions containing CMV DNA (including viral load) and/or elevated WBC counts (> 5 x 106) to calculate the risk of TT-CMV with transfusion of units that are CMV DNA+ or failed leukoreduction. We believe this study will represent the definitive analysis of the CMV safety of CMV-seronegative + leukoreduced transfusions, and will inform future transfusion decisions for these high risk populations. This project addresses the PPG central theme since LBWI are very susceptible to opportunistic infections, like CMV: Thus, TT-CMV in this population is a serious hazard. The results of the proposed investigation will demonstrate whether CMV-seronegative + leukoreduced transfusions are optimally safe for LBWI, or whether breakthrough cases of TT-CMV occur and could be prevented by CMV NAT and 100% leukoreduction QC. This project interacts with Projects 1 and 3 and utilizes cores A and C. Both Projects 1 and 3 are focused on developing approaches (preclinical and clinical, respectively) to accelerate immune reconstitution in HPCT recipients to prevent disease from opportunistic infections, including CMV. Project 2 synergizes with this objective by validating approaches to prevent CMV transmission to this population through blood components that are optimally CMV-safe. This project will also make use of the Administrative Core (A) to oversee all IRB applications and approvals, and the Biostatistics and Data Management Core (C) for study design, ongoing statistical analysis of data, and data safety monitoring (DSM plan) functions.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Research Program Projects (P01)
Project #
5P01HL086773-05
Application #
8343357
Study Section
Heart, Lung, and Blood Initial Review Group (HLBP)
Project Start
Project End
2014-08-31
Budget Start
2012-09-01
Budget End
2013-08-31
Support Year
5
Fiscal Year
2012
Total Cost
$1,820,356
Indirect Cost
$608,326
Name
Emory University
Department
Type
DUNS #
066469933
City
Atlanta
State
GA
Country
United States
Zip Code
30322
Auletta, J J; Devine, S M; Waller, E K (2016) Plasmacytoid dendritic cells in allogeneic hematopoietic cell transplantation: benefit or burden? Bone Marrow Transplant 51:333-43
Patel, Ravi M; Knezevic, Andrea; Shenvi, Neeta et al. (2016) Association of Red Blood Cell Transfusion, Anemia, and Necrotizing Enterocolitis in Very Low-Birth-Weight Infants. JAMA 315:889-97
Rao, Anuradha; Kosters, Astrid; Mells, Jamie E et al. (2016) Inhibition of ileal bile acid uptake protects against nonalcoholic fatty liver disease in high-fat diet-fed mice. Sci Transl Med 8:357ra122
Jones, Dean P (2016) Sequencing the exposome: A call to action. Toxicol Rep 3:29-45
de Wolski, Karen; Fu, Xiaoyoun; Dumont, Larry J et al. (2016) Metabolic pathways that correlate with post-transfusion circulation of stored murine red blood cells. Haematologica 101:578-86
Hayek, Salim S; MacNamara, James; Tahhan, Ayman S et al. (2016) Circulating Progenitor Cells Identify Peripheral Arterial Disease in Patients With Coronary Artery Disease. Circ Res 119:564-71
Stowell, Sean R; Girard-Pierce, Kathryn R; Smith, Nicole H et al. (2014) Transfusion of murine red blood cells expressing the human KEL glycoprotein induces clinically significant alloantibodies. Transfusion 54:179-89
James, Adelbert B; Josephson, Cassandra D; Shaz, Beth H et al. (2014) The value of area-based analyses of donation patterns for recruitment strategies. Transfusion 54:3051-60
Josephson, Cassandra D; Caliendo, Angela M; Easley, Kirk A et al. (2014) Blood transfusion and breast milk transmission of cytomegalovirus in very low-birth-weight infants: a prospective cohort study. JAMA Pediatr 168:1054-62
Marin, Terri; Josephson, Cassandra D; Kosmetatos, Niki et al. (2014) Feeding preterm infants during red blood cell transfusion is associated with a decline in postprandial mesenteric oxygenation. J Pediatr 165:464-71.e1

Showing the most recent 10 out of 26 publications