Features of Cytomegalovirus DNAemia Blips in Allogeneic Hematopoietic Stem Cell Transplant Recipients: Implications for Optimization of Preemptive Antiviral Therapy Strategies
| Autor: | Dixie Huntley, Estela Giménez, Alberto Talaya, Carlos Solano, David Navarro, Eliseo Albert, José Luis Piñana, Rafael Hernani, Juan Alberola, Juan Carlos Hernández-Boluda, A. Martínez, Ignacio Torres |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
medicine.medical_specialty Congenital cytomegalovirus infection Cytomegalovirus Antiviral Agents 03 medical and health sciences 0302 clinical medicine Internal medicine medicine Humans Retrospective Studies First episode Transplantation business.industry Incidence (epidemiology) Antiviral therapy Hematopoietic Stem Cell Transplantation virus diseases Retrospective cohort study Hematology Cmv dnaemia medicine.disease Transplant Recipients Highly sensitive 030220 oncology & carcinogenesis Cytomegalovirus Infections DNA Viral Allogeneic hematopoietic stem cell transplant business 030215 immunology |
| Zdroj: | Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 26(5) |
| ISSN: | 1523-6536 |
| Popis: | Cytomegalovirus (CMV) DNAemia occurs frequently in allogeneic hematopoietic stem cell transplant recipients (allo-HSCT). There is limited information about the incidence, features, and clinical impact of CMV DNAemia blips (episodes defined by an isolated positive PCR result) in this setting. In this retrospective study, 225 consecutive adult patients undergoing any modality of allo-HSCT at our center between May 2012 and July 2019 were included. Plasma CMV DNA load was monitored using a highly sensitive real-time PCR assay. In all, 187 of 225 patients had CMV DNAemia through day 365 after allo-HSCT (total number of episodes, n = 379). Eighty-three of the 187 patients had 1 or more blips (n = 104). Blips occurred as a first episode of CMV DNAemia as opposed to prolonged CMV DNAemia (≥2 consecutive positive PCR results) in 47 patients; in 20 of these patients, blips represented the only documented episode throughout the study period, and in 27 patients, blips preceded a prolonged CMV DNAemia episode. In the remaining 36 patients, blips developed as recurrences. Blips presenting as initial episodes occurred more frequently (P.001) in patients receiving an allograft from a CMV-seropositive donor. The cumulative incidence of recurrent CMV DNAemia following initial blips, self-resolving prolonged CMV DNAemia episodes, or CMV DNAemia episodes treated preemptively with antivirals was not significantly different (P = .34). Receiver operating characteristic curve analysis indicated that a CMV DNA load cutoff of 48 IU/mL yielded the highest combined sensitivity (66%) and specificity (70.2%) for predicting a prolonged CMV DNAemia episode. The practical implications of our data in the optimization of preemptive antiviral therapy strategies are discussed. |
| Databáze: | OpenAIRE |
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