[Application of real time polymerase chain reaction to the diagnosis and treatment of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation].
OBJECTIVE
To investigate the role of real time quantitative polymerase chain reaction (RQ-PCR) in the diagnosis and treatment of recipients cytomegalovirus (CMV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT).


METHODS
318 patients received allo-HSCT were studied. 160 patients received transplants from HLA matched sibling donors; 127 from HLA mismatched related donors; 31 from unrelated donors. Before transplant recipients and donors received CMV serological test by ELISA. After transplant RQ-PCR was used to test and monitor CMV-DNA in plasma of patients. A positive CMV-PCR was defined as > 6 x 10(2) copies/ml. Ganciclovir was used for CMV prophylaxis in all patients at -9 d to -2 d of conditioning regimen period. Ganciclovir, foscarnet, or combination of the two drugs were used as the preemptive therapy.


RESULTS
The total 100-day cumulative incidence of CMV infection was 40.6%. The incidence was 17.5%, 66.1% and 45.2% for the HLA matched sibling, HLA mismatched related (MMR) and unrelated donor (MUR) HSCT respectively. Multivariate analysis showed MMR HSCT, MUR HSCT, ATG containing preparative regimen and moderate to severe aGVHD were the risk factors for CMV infection after HSCT. The 100 day cumulative incidence of CMV disease was 8.8% and 5.6%, 9.4%, 22.6% respectively for total and three kinds of HSCT after early preemptive therapy. Two-year survival of CMV infection was similar in the three kinds of SCT.


CONCLUSIONS
Detection of CMV DNA in plasma by real time PCR appears to be effective for the diagnosis and surveillance of CMV infection after HSCT. It may help to initiate antiviral therapy and reduce the incidence of CMV disease in the patients with high risk of CMV infection.
Chen
Huan
H
Institute of Hematology, Peking University, People's Hospital, Beijing 100044, China.
Liu
Kai-yan
KY
Xu
Lan-ping
LP
Liu
Dai-hong
DH
Chen
Yu-hong
YH
Zhao
Xiao-su
XS
Yu
Li
L
Han
Wei
W
Zhang
Xiao-hui
XH
Wang
Yu
Y
Chen
Yao
Y
Huang
Xiao-jun
XJ
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000235:genetics; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D016133:Polymerase Chain Reaction / Q000379:methods*; D011183:Postoperative Complications / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology; D012189:Retrospective Studies; D055815:Young Adult
D004279:DNA, Viral