title: Monitoring of human cytomegalovirus and virus-specific T-cell response in young patients receiving allogeneic hematopoietic stem cell transplantation.
abstract: In allogeneic hematopoietic stem-cell transplantation (HSCT) recipients, outcome of human cytomegalovirus (HCMV) infection results from balance between viral load/replication and pathogen-specific T-cell response. Using a cut-off of 30,000 HCMV DNA copies/ml blood for pre-emptive therapy and cut-offs of 1 and 3 virus-specific CD4(+) and CD8(+) T cells/µl blood for T-cell protection, we conducted in 131 young patients a prospective 3-year study aimed at verifying whether achievement of such immunological cut-offs protects from HCMV disease. In the first three months after transplantation, 55/89 (62%) HCMV-seropositive patients had infection and 36/55 (65%) were treated pre-emptively, whereas only 7/42 (17%) HCMV-seronegative patients developed infection and 3/7 (43%) were treated. After 12 months, 76 HCMV-seropositive and 9 HCMV-seronegative patients (cumulative incidence: 90% and 21%, respectively) displayed protective HCMV-specific immunity. Eighty of these 85 (95%) patients showed spontaneous control of HCMV infection without additional treatment. Five patients after reaching protective T-cell levels needed pre-emptive therapy, because they developed graft-versus-host disease (GvHD). HSCT recipients reconstituting protective levels of HCMV-specific T-cells in the absence of GvHD are no longer at risk for HCMV disease, at least within 3 years after transplantation. The decision to treat HCMV infection in young HSCT recipients may be taken by combining virological and immunological findings.
authors: Laboratori Sperimentali di Ricerca, Area Trapiantologica, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy.
authors: Daniele
authors: D
authors: Lilleri
authors: Giuseppe
authors: G
authors: Gerna
authors: Paola
authors: P
authors: Zelini
authors: Antonella
authors: A
authors: Chiesa
authors: Vanina
authors: V
authors: Rognoni
authors: Angela
authors: A
authors: Mastronuzzi
authors: Giovanna
authors: G
authors: Giorgiani
authors: Marco
authors: M
authors: Zecca
authors: Franco
authors: F
authors: Locatelli
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003587:Cytomegalovirus / Q000276:immunology* / Q000502:physiology*; D003586:Cytomegalovirus Infections / Q000209:etiology / Q000276:immunology; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D008297:Male; D013045:Species Specificity; D013601:T-Lymphocytes / Q000276:immunology*; D014184:Transplantation, Homologous / Q000009:adverse effects; D055815:Young Adult