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Incidence of cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell recipients at low risk of CMV infection

Bone Marrow Transplantation volume 29, pages 1005–1006 (2002)Cite this article

Butt and Clark1 recently reported a high frequency of positive surveillance results for cytomegalovirus (CMV) by using polymerase chain reaction (PCR) in allogeneic hematopoietic stem cell recipients at low risk of CMV infection. In their report, six (55%) of 11 low-risk patients, defined as CMV seronegative recipients with CMV seronegative donors (R−D−), yielded positive PCR results. Except for two patients who had to receive limited units of CMV unscreened platelets for hemorrhagic emergency, the rest of the patients received CMV seronegative blood products. Because of the higher prevalence of CMV seropositivity in Japan as compared with Western countries, the frequency of R−D− pairs is much lower. Among the 146 recipients of allografts at our institution between May 1996 and July 2001, 15 patients were found to be at low risk for CMV infection (R−D−). Patient characteristics are shown in Table 1. All patients exclusively received CMV seronegative blood products, which were also irradiated and filtered to deplete leukocytes before transfusion using a Sepacell Filter (Asahi Medical Company, Tokyo, Japan). After engraftment, CMV surveillance was performed prospectively with a CMV antigenemia assay using monoclonal antibodies (C10/C11) as previously described, until intensive immunosuppressive therapy, particularly glucocorticoids, was discontinued.2 In 14 patients, CMV monitoring was also retrospectively performed by real-time PCR using serially stored, frozen plasma as previously described.2 The sensitivity of the real-time PCR assay was 20 copies per100 μl of plasma. Only one (6.7%) of the 15 low-risk patients became CMV antigenemia-positive, and two (14.3%) of the 14 evaluable patients yielded positive PCR results (Table 1). One patient with positive PCR and negative CMV antigenemia developed histologically diagnosed CMV gastritis. The other patient with both positive PCR and CMV antigenemia results was treated with ganciclovir pre-emptively and never developed CMV disease.

Table 1 Patient characteristics and incidence of CMV infection and disease
Full size table

In our analysis, the incidence of CMV infection in low-risk patients was notably lower than that shown by Butt and Clark. Previous studies also demonstrated a very low incidence of CMV infection in low-risk (R−D−) patients using viral culture and CMV antigenemia assay.3,4 This difference could be explained by the sensitivity of surveillance assays used in each study. We performed real-time PCR using plasma samples in addition to CMV antigenemia assay, while Butt and Clark used whole blood instead of plasma for PCR assay. PCR of whole blood or leukocytes has been shown to be more sensitive than that of plasma to detect CMV reactivation.5,6 However, we think that the use of plasma for PCR allows the detection of only free virions indicating active viral replication, which may be more clinically relevant. In addition, the semiquantitative PCR of plasma has been previously shown to correlate with the risk of CMV diseases.7

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References

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Authors and Affiliations

  1. Division of Hematology, Department of Medicine, Keio University School of Medicine, Tokyo, Japan

    T Mori, S Okamoto, R Watanabe, R Yamazaki, Y Tsukada, H Nagayama & Y Ikeda

  2. Blood Center, Keio University School of Medicine, Tokyo, Japan

    A Ishida

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  1. T Mori
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  2. S Okamoto
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Mori, T., Okamoto, S., Watanabe, R. et al. Incidence of cytomegalovirus (CMV) infection in allogeneic hematopoietic stem cell recipients at low risk of CMV infection. Bone Marrow Transplant 29, 1005–1006 (2002). https://doi.org/10.1038/sj.bmt.1703588

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