Temporal trends in transfusion-transmitted cytomegalovirus infection among cytomegalovirus-seronegative HSCT recipients

Background: The incidence of transfusion-transmitted cytomegalovirus (TT-CMV) after hematopoietic stem cell transplantation (HSCT) in the era of universal leukoreduction remains unclear. This study evaluated temporal changes in TT-CMV and clinically significant CMV infection (csCMVi) in Japan. Methods: Data from 5,016 CMV-seronegative HSCT recipients registered between 1999 and 2022 were retrospectively analyzed. TT-CMV was defined as CMV antigenemia and/or CMV disease, and csCMVi as the initiation of pre-emptive therapy or CMV disease. Results: Random donor (RD) blood products were independently associated with TT-CMV (odds ratio 2.35, 95% confidence interval 1.75–3.15, P < 0.001) and csCMVi (subdistribution hazard ratio 2.22, 95% CI 1.67–2.96, P < 0.001). Among allogeneic HSCT recipients receiving RD blood products, TT-CMV decreased from 25.7% in 2007–2020 to 12.7% in 2021–2022, while the 100-day cumulative incidence of csCMVi decreased from 24.7% to 8.3% over the same periods. During 2021–2022, differences between RD and CMV-seronegative donor blood products were not statistically significant. CMV disease incidence did not differ between groups. Conclusions: TT-CMV and csCMVi decreased substantially over time. Although RD blood products remained associated with higher overall risk, the additional benefit of CMV-seronegative blood products may be limited under contemporary transfusion practices.