Comparison of antigenemia assay and semiquantitative polymerase chain reaction test for monitoring active cytomegalovirus infection in allogeneic hematopoietic cell transplant recipients.
OBJECTIVE
We sought to compare the antigenemia assay and in-house semiquantitative polymerase chain reaction to monitor human cytomegalovirus infection after transplant in hematopoietic cell transplant recipients.


METHODS
A pp65 antigen test for polymorphonuclear leukocytes and a semiquantitative polymerase chain reaction for whole blood were performed for 201 samples obtained from 26 hematopoietic cell transplant recipients over a 3-month surveillance period.


RESULTS
Fourteen episodes of antigenemia positivity were detected in 7 patients in whom human cytomegalovirus DNA loads and pp65-positive cells ranged between < 102 to 2.96 x 104 copies/mL and 0-35/ 5 x 104 polymorphonuclear leukocytes, respectively. A significant correlation was detected between human cytomegalovirus DNA load and the antigenemia test. A receiver operating characteristic analysis determined 5000 copies/mL of human cytomegalovirus as the threshold value for initiation of ganciclovir therapy.


CONCLUSIONS
Based on a comparison of the pp65 antigenemia assay, quantification of human cytomegalovirus DNA in whole blood can be used to guide clinical management of hematopoietic cell transplant recipients. This approach may have important advantages including superior sensitivity and efficient monitoring of preemptive therapy, allowing inclusion of kinetic criteria in clinical guidelines. Furthermore, a high human cytomegalovirus load among patients with grade II-IV acute graft-versus-host disease may indicate a high risk of human cytomegalovirus disease among hematopoietic cell transplant patients. Human cytomegalovirus reactivation must be monitored using more-sensitive assays such as real-time polymerase chain reaction.
Pajand
O
O
Microbiology Department, Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran. om24pa@yahoo.com
Ziyaeyan
M
M
Mousavi
Sa
S
Fatolahzadeh
B
B
Hojabri
Z
Z
Bahador
A
A
Abdossamadi
Z
Z
D000293:Adolescent; D000328:Adult; D000998:Antiviral Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000235:genetics*; 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; D007963:Leukocytes, Mononuclear / Q000821:virology; D008297:Male; D008875:Middle Aged; D010750:Phosphoproteins / Q000097:blood*; D016133:Polymerase Chain Reaction / Q000379:methods*; D012372:ROC Curve; D012680:Sensitivity and Specificity; D019562:Viral Load; D014763:Viral Matrix Proteins / Q000097:blood*
D000998:Antiviral Agents; D004279:DNA, Viral; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa; D015774:Ganciclovir