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Post-Transplant Events

Active CMV disease does not always correlate with viral load detection

Bone Marrow Transplantation volume 40, pages 55–61 (2007)Cite this article

Abstract

The use of quantitative cytomegalovirus (CMV) real-time polymerase chain reaction (RT-PCR) and preemptive ganciclovir therapy is replacing prophylaxis as the management of choice in high-risk patients undergoing stem cell transplantation (SCT). However, there are limited data defining its role in this setting. In the current retrospective single-centre study, quantitative RT-PCR was used to determine CMV in 577 consecutive patients undergoing SCT (172 allogeneic and 405 autologous) over a 5-year period. CMV RT-PCR was performed weekly until cessation of immunosuppression (allogeneic) or for 30 days post-SCT (autologous). Treatment was commenced after two consecutive positive results or a high copy on the first occasion (>1000 copies/ml, >3 log). The overall CMV reactivation rate in patients undergoing allogeneic SCT was 30%, with reactivation observed in 72% of high-risk patients (recipient positive patients). CMV end-organ disease was observed in eight patients (1%); of these, four were CMV RT-PCR negative at the time of diagnosis of end-organ CMV disease, with three remaining negative throughout the course of the disease. CMV-related mortality was recorded in three patients. The current data support a preemptive treatment strategy-based CMV RT-PCR, but indicate that in symptomatic patients, a negative CMV PCR result does not exclude CMV end-organ disease.

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Authors and Affiliations

  1. Department of Haematology, University of Manchester, Christie Hospital, Manchester, UK

    J Ruell, C Barnes, B Foulkes, J Chang, J Cavet & R Chopra

  2. Health Protection Agency North West Laboratory, University of Manchester, Manchester Royal Infirmary, Manchester, UK

    K Mutton & M Guiver

  3. Department of Histopathology, Christie Hospital, Manchester, UK

    L Menasce

  4. Department of Statistics, Christie Hospital, Manchester, UK

    M Dougal

Authors
  1. J Ruell
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  2. C Barnes
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  3. K Mutton
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  4. B Foulkes
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  5. J Chang
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  6. J Cavet
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  7. M Guiver
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  8. L Menasce
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  9. M Dougal
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  10. R Chopra
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Correspondence to J Ruell.

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Ruell, J., Barnes, C., Mutton, K. et al. Active CMV disease does not always correlate with viral load detection. Bone Marrow Transplant 40, 55–61 (2007). https://doi.org/10.1038/sj.bmt.1705671

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