Level and onset of cmv-pp65 antigenemia as determinants of risk for cmv-related complications in stem cell transplant recipients

Abstract EN

This study was carried out to investigate if quantification of CMV antigen can be used to risk adapt the prophylaxis for CMV infection in stem cell transplant recipients in order to reduce the cost and the number of patients who are exposed to ganciclovir.

Assay for CMV early antigen pp65 on circulating leukocytes was used to monitor early CMV infection in 54 consecutive patients undergoing peripheral blood stem cell transplantation (PBSCT).

A total of 201 samples were examined for CMV antigen in peripheral blood leukocytes by the slide method and 40 samples were additionally investigated by flow cytometry.

Of 54 patients examined, twenty five patients (46 %) were positive for CMV pp65 antigen.

Eleven of these patients developed CMV disease following PBSCT.

Patients who suffered from CMV disease showed statistically significantly higher OT levels (p = 0.003), higher frequency of complications (p = 0.008) and unfavorable outcome (p = 0.002).

Patients who were positive for CMV antigen had a 4.5 times higher risk to develop GVHD.

In multivariate analysis, we found that CMV pp65 antigen positivity was the only factor which was independently related to GVHD.

On comparing the detection of antigenemia by the slide method to that by flow cytometry, the slide method was statistically significantly more sensitive in diagnosing patients who manifested with CMV-related disease (p = 0.01).

Thus, antigenemia can be used to assign PBSCT recipients at risk for CMV disease and risk adapted prophylaxis for CMV can be carried out according to the level of CMV positive leukocytes.