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Role of quantitative human cytomegalovirus PCR in predicting antiviral treatment response among high-risk hematopoietic stem-cell transplant recipients

Bone Marrow Transplantation volume 33, pages 463–464 (2004)Cite this article

Human cytomegalovirus (HCMV) reactivation poses a serious challenge in patients undergoing allogeneic hematopoietic stem-cell transplantation (HSCT) for an underlying hematologic malignancy.1 Predictors of HCMV-treatment response in patients receiving prophylactic and/or pre-emptive anti-HCMV therapy during high-risk post transplant periods remain uncertain.2 Shell-vial culture, pp65 antigenemia assay, qualitative peripheral blood leukocyte (PBL) PCR, qualitative serum PCR and semiquantitative plasma or PBL HCMV PCR are currently employed in hybrid protocols to determine viral reactivation and response to therapy.3,4 In this prospective study (January 1999–December 2000), serial qualitative PCR and quantitative PCR were performed weekly (−10 to +100 days) in HCMV-seropositive recipients of allogeneic HSCT at Palmetto-Richland Memorial Hospital, Columbia, South Carolina.5 HCMV quantitative-PCR (CMV Ultraquant assay, Specialty Laboratories, Santa Monica, CA) used 5′–3′ exonuclease activity of Taq DNA polymerase Gold (PE Applied Biosystems, Foster City, CA, USA) for direct detection of the amplified PCR product (CMV DNA polymerase gene) by the release of a fluorescent reporter. The detection range for this test was 200 to 1 million copies/ml.

By quantitative PCR, HCMV was detected as early as 7 days post HSCT, whereas qualitative PCR detected viral presence in peripheral blood lymphocytes after the third week of transplantation (24–38 days post HSCT). Quantitative PCR was positive in the setting of low-level viral DNA presence (234 copies/ml), whereas, for qualitative PCR to become positive, >2000 HCMV copies/ml were needed. In three patients with early post transplant viral detection on days 7, 12, and 17, levels of peripheral blood lymphocyte viral burden were lower (234, 311, and 258 copies/ml, respectively) compared to patients in whom HCMV was detected late (days 26 (1270 copies/ml); day 31 (1312 copies/ml), and day 35 (9307 copies/ml)).

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Authors and Affiliations

  1. University of South Carolina School of Medicine, Columbia, SC, USA

    A Safdar, M Bruorton, J P Henslee-Downey & F van Rhee

  2. The Department of Infectious Diseases, Infection Control, and Employee Health, 402, University of Texas MD Anderson Cancer Center, Holcombe Boulevard 1515, Houston, 77030, TX, USA

    A Safdar

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  1. A Safdar
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  2. M Bruorton
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  4. F van Rhee
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Safdar, A., Bruorton, M., Henslee-Downey, J. et al. Role of quantitative human cytomegalovirus PCR in predicting antiviral treatment response among high-risk hematopoietic stem-cell transplant recipients. Bone Marrow Transplant 33, 463–464 (2004). https://doi.org/10.1038/sj.bmt.1704375

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