Rising antigenemia levels may be misleading in pre-emptive therapy of human cytomegalovirus infection in allogeneic hematopoietic stem cell transplant recipients.
OBJECTIVE
Hematopoietic stem cell transplant (HSCT) recipients after show rising levels of antigenemia during pre-emptive ganciclovir treatment of human cytomegalovirus (HCMV) infection. This raises some doubts about the therapeutic decisions to be taken.


METHODS
Three groups of HSCT recipients with HCMV infection undergoing anti-viral treatment were identified: group A, showing increasing antigenemia and decreasing viremia and DNAemia; group B, with simultaneous increases in antigenemia, viremia, and DNAemia; and group C, with decreasing levels of all 3 viral markers. Viral load, determined as levels of antigenemia, viremia and DNAemia, was monitored for 3 months post-transplantation in all groups.


RESULTS
Group A HSCT recipients showed antigenemia peaks 2-11 days after the onset of treatment, reaching negative levels only 25-30 days thereafter, whereas viremia and DNAemia started to drop earlier. Group B patients, mainly including HSCT recipients with grade II-IV acute GvHD treated with steroids prior to and during antiviral treatment, showed increasing levels of all three viral parameters until 5-10 days after the start of treatment; the levels dropped to negative values 25-30 days thereafter. Group C patients, who acted as controls, progressively cleared virus from blood as an early result of antiviral therapy.


CONCLUSIONS
Antigenemia is not the best assay to guide pre-emptive therapy. Group A patients, who have an isolated increase of antigenemia, do not require a change of the ongoing antiviral therapy. Whether better control of infection could be obtained in group B patients by either reducing immunosuppressive therapy (when possible) or adopting combination therapy remains to be determined.
Gerna
Giuseppe
G
Servizio di Virologia, Oncoematologia Pediatrica, and Centro Trapianti di Midollo Osseo, Divisione di Ematologia, IRCCS Policlinico San Matteo, 27100 Pavia, Italy. gerna@smatteo.pv.it
Lilleri
Daniele
D
Zecca
Marco
M
Alessandrino
Emilio Paolo
EP
Baldanti
Fausto
F
Revello
Maria Grazia
MG
Locatelli
Franco
F
D000293:Adolescent; D000328:Adult; D000956:Antigens, Viral / Q000097:blood*; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003586:Cytomegalovirus Infections / Q000188:drug therapy* / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D014184:Transplantation, Homologous; D019562:Viral Load; D014766:Viremia / Q000188:drug therapy* / Q000601:surgery / Q000628:therapy
D000956:Antigens, Viral; D000998:Antiviral Agents; D004279:DNA, Viral