Quantification of CMV viraemia in a case of transfusion-related graft-versus-host disease associated with purine analogue treatment.
We report a patient who developed transfusion-associated graft-versus-host-disease (GvHD) and concurrent cytomegalovirus (CMV) infection, both complications thought to be related to severe T lymphocyte depletion induced by treatment with a purine analogue drug, fludarabine. CMV viraemia was detected by qualitative PCR and the viral load in positive samples was measured using a fully quantitative PCR assay. This quantitative assay enabled the evaluation of the efficacy of antiviral interventions based on the qualitative PCR result. The case illustrates the risks associated with the use of purine analogue drugs, as well as the value of quantitative CMV PCR assays for monitoring CMV infection in immunocompromised patients.
Deane
M
M
Department of Haematology, Royal Free Hospital and School of Medicine, London.
Gor
D
D
Macmahon
M E
ME
Emery
V
V
Griffith
P D
PD
Cummins
M
M
Prentice
H G
HG
D000208:Acute Disease; D000328:Adult; D000970:Antineoplastic Agents / Q000009:adverse effects*; D003586:Cytomegalovirus Infections / Q000209:etiology*; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000209:etiology*; D006801:Humans; D016867:Immunocompromised Host; D007951:Leukemia, Myeloid / Q000188:drug therapy*; D008231:Lymphopenia / Q000139:chemically induced*; D013601:T-Lymphocytes; D065227:Transfusion Reaction; D014740:Vidarabine / Q000009:adverse effects / Q000031:analogs & derivatives*; D014766:Viremia / Q000209:etiology
D000970:Antineoplastic Agents; D014740:Vidarabine; C024352:fludarabine