Extended antigenemia surveillance and late cytomegalovirus infection after allogeneic BMT.
Late CMV disease remains a major concern in allogeneic BMT recipients. Few surveillance data are available on the occurrence of CMV infection and recurrences after day +100. We evaluated the occurrence of antigenemia (AG) recurrences until day +365 in 76 patients who received pre-emptive ganciclovir (GCV) therapy prompted by AG > or = 2 positive cells. Sixty-two episodes of AG recurrences were detected in 33 of the 52 patients who had positive AG. Survival analysis showed a 45.4% probability of AG recurrence on day +100, 64.8% on day +180 and 71.2% on day +365. The median time for AG recurrences was 113 (35 to 343) days. Thirty-five of the 62 episodes (56.4%) occurred after day +100. More than 70% of the patients responded to a 2-week course of GCV and no CMV disease was observed shortly after discontinuation of GCV. The Cox proportional model showed a significant effect of AG recurrences on patient's follow-up only when the patient developed chronic GVHD (P = 0.012). Extended surveillance favored early introduction of GCV and late CMV pneumonia occurred in only one of the 76 patients (1.3%). AG recurrences are frequent after day +100 and extended surveillance until day +365 is recommended for patients who develop chronic GvHD.
Machado
C M
CM
Virology Laboratory (LIM 52-HCFMUSP) of Instituto de Medicina Tropical de São Paulo, São Paulo, Brazil.
Menezes
R X
RX
Macedo
M C
MC
Mendes
A V
AV
Boas
L S
LS
Castelli
J B
JB
Dulley
F L
FL
Pannuti
C S
CS
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000097:blood*; D016026:Bone Marrow Transplantation / Q000009:adverse effects* / Q000276:immunology*; D002675:Child, Preschool; D002908:Chronic Disease; D003587:Cytomegalovirus / Q000187:drug effects / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000276:immunology* / Q000401:mortality / Q000517:prevention & control; D005500:Follow-Up Studies; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D055502:Secondary Prevention; D015996:Survival Rate; D014184:Transplantation, Homologous
D000956:Antigens, Viral; D015774:Ganciclovir