title: A prospective study comparing quantitative Cytomegalovirus (CMV) polymerase chain reaction in plasma and pp65 antigenemia assay in monitoring patients after allogeneic stem cell transplantation.
abstract: BACKGROUND
  Low levels of Cytomegalovirus (CMV) viral load are frequently detected following allogeneic stem cell transplantation (SCT) and CMV disease may still develop in some allogeneic SCT patients who have negative pp65-antigenemia (pp65-Ag) or undetectable DNA. Pp65Ag is a sensitive method to diagnose CMV infection. Quantitative CMV-DNA PCR assay in plasma has been proposed to monitor CMV infection in SCT patients. We evaluated the clinical utility of pp65Ag and PCR assay in plasma of SCT recipients.
  
  
  METHODS
  In a prospective longitudinal study, 38 consecutive patients at risk of CMV infection (donor and/or recipient CMV seropositive) were weekly monitored for CMV infection by both quantitative CMV-PCR in plasma (COBAS AMPLICOR CMV MONITOR) and pp65 Ag, during the first 100 days after SCT.
  
  
  RESULTS
  A total of 534 blood samples were simultaneously analysed for pp65Ag and PCR. Overall, 28/38 patients (74%) had active CMV infection within 100 days from SCT. In 16 patients, CMV was first detected by pp65 Ag alone; in 5 patients by both methods and in 6 by PCR assay alone; one patient had CMV biopsy-proven intestinal disease without pp65Ag and PCR assays positivity before CMV disease. Overall, three patients developed intestinal CMV disease (7.9%): one had negative both pp65Ag and PCR assays before CMV disease, one had disease and concomitant positivity of both methods, while in the remaining patient, only pp65Ag was positive before CMV disease.
  
  
  CONCLUSIONS
  Plasma PCR(COBAS AMPLICOR CMV MONITOR) and pp65Ag assays were effective in detecting CMV infection, however, discordance between both methods were frequently observed. Plasma PCR and pp65Ag assays may be complementary for diagnosis and management of CMV infection.
authors.affiliation: Department of Cellular Biotechnology and Hematology, Univ, La Sapienza, Rome, Italy. gentile@bce.uniroma1.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Gentile
authors.forename: Alessandra
authors.initials: A
authors.lastname: Picardi
authors.forename: Angela
authors.initials: A
authors.lastname: Capobianchi
authors.forename: Alessandra
authors.initials: A
authors.lastname: Spagnoli
authors.forename: Laura
authors.initials: L
authors.lastname: Cudillo
authors.forename: Teresa
authors.initials: T
authors.lastname: Dentamaro
authors.forename: Andrea
authors.initials: A
authors.lastname: Tendas
authors.forename: Luca
authors.initials: L
authors.lastname: Cupelli
authors.forename: Marco
authors.initials: M
authors.lastname: Ciotti
authors.forename: Antonio
authors.initials: A
authors.lastname: Volpi
authors.forename: Sergio
authors.initials: S
authors.lastname: Amadori
authors.forename: Pietro
authors.initials: P
authors.lastname: Martino
authors.forename: Paolo
authors.initials: P
authors.lastname: de Fabritiis
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000821:virology; D004279:DNA, Viral / Q000097:blood*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood*; D016133:Polymerase Chain Reaction / Q000379:methods*; D011446:Prospective Studies; D033581:Stem Cell Transplantation / Q000009:adverse effects*; D014184:Transplantation, Homologous; D019562:Viral Load; D014763:Viral Matrix Proteins / Q000097:blood*; D014766:Viremia / Q000821:virology
chemical_list: D004279:DNA, Viral; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa