title: Monitoring of cytomegalovirus reactivation after allogeneic stem cell transplantation: comparison of an antigenemia assay and quantitative real-time polymerase chain reaction.
abstract: Cytomegalovirus (CMV) antigenemia and quantitative real-time polymerase chain reaction (PCR) were compared for monitoring of CMV reactivation after allogeneic stem cell transplantation. The number of CMV antigen-positive cells by the antigenemia assay and the level of CMV DNA by real-time PCR correlated well. The sensitivity and specificity of the antigenemia assay was 55.4% and 95.5%, respectively, using real-time PCR as the reference standard. The probability of positive antigenemia at day 100 was 76.5%, with a median of first detection at day 37 in 51 patients, compared with a positive PCR of 84.3% and day 33, respectively. When HLA-identical sibling donor transplant recipients and other donor transplant recipients were analyzed separately, there was no difference between the two tests. However, temporal patterns of first detection of CMV antigen-positive cells and CMV DNA differed between HLA-identical and alternative recipients; patients without CMV (29%) or with sporadic positive PCR results (14%) were more common in HLA-identical sibling transplants, whereas patients with simultaneous antigenemia and positive PCR occurred more in alternative transplants (48%). Two of 51 patients (4%) developed CMV colitis despite antigenemia-guided prophylaxis, but both were successfully treated with ganciclovir. Although PCR is more sensitive than antigenemia, both tests are useful in the early detection of CMV after allogeneic stem cell transplantation.
authors.affiliation: Second Department of Internal Medicine, Kurume University School of Medicine, Kurume, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yakushiji
authors.forename: H
authors.initials: H
authors.lastname: Gondo
authors.forename: K
authors.initials: K
authors.lastname: Kamezaki
authors.forename: K
authors.initials: K
authors.lastname: Shigematsu
authors.forename: S
authors.initials: S
authors.lastname: Hayashi
authors.forename: M
authors.initials: M
authors.lastname: Kuroiwa
authors.forename: S
authors.initials: S
authors.lastname: Taniguchi
authors.forename: Y
authors.initials: Y
authors.lastname: Ohno
authors.forename: K
authors.initials: K
authors.lastname: Takase
authors.forename: A
authors.initials: A
authors.lastname: Numata
authors.forename: K
authors.initials: K
authors.lastname: Aoki
authors.forename: K
authors.initials: K
authors.lastname: Kato
authors.forename: K
authors.initials: K
authors.lastname: Nagafuji
authors.forename: K
authors.initials: K
authors.lastname: Shimoda
authors.forename: T
authors.initials: T
authors.lastname: Okamura
authors.forename: N
authors.initials: N
authors.lastname: Kinukawa
authors.forename: N
authors.initials: N
authors.lastname: Kasuga
authors.forename: M
authors.initials: M
authors.lastname: Sata
authors.forename: M
authors.initials: M
authors.lastname: Harada
mesh_terms: D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use; D003092:Colitis / Q000188:drug therapy / Q000209:etiology / Q000821:virology; D003199:Computer Systems; D003587:Cytomegalovirus / Q000235:genetics / Q000254:growth & development* / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D015774:Ganciclovir / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D015994:Incidence; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009679:Nuclear Family; D016133:Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D014019:Tissue Donors; D014184:Transplantation, Homologous; D014766:Viremia / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy; D014775:Virus Activation
chemical_list: D000956:Antigens, Viral; D000998:Antiviral Agents; D004279:DNA, Viral; D015774:Ganciclovir