title: Utility of the Enzyme-Linked Immunospot Interferon-γ-Release Assay to Predict the Risk of Cytomegalovirus Infection in Hematopoietic Cell Transplant Recipients.
abstract: The ability to distinguish allogeneic hematopoietic cell transplant (allo-HCT) recipients at risk for cytomegalovirus (CMV) reactivation from those who are not is central for optimal CMV management strategies. Interferon γ (IFN-γ) produced by CMV-challenged T cells may serve as an immune marker differentiating these 2 populations. We prospectively monitored 63 CMV-seropositive allo-HCT recipients with a CMV-specific enzyme-linked immunospot (ELISPOT) assay and for CMV infection from the period before transplantation to day 100 after transplantation. Assay results above certain thresholds (50 spots per 250 000 cells for immediate early 1 or 100 spots per 250 000 cells for phosphoprotein 65) identified patients who were protected against CMV infection as long as they had no graft-versus-host disease and/or were not receiving systemic corticosteroids. Based on the multivariable Cox proportional hazards regression model, the only significant factor for preventing CMV reactivation was a CMV-specific ELISPOT response above the determined thresholds (adjusted hazard ratio, 0.21; 95% confidence interval, .05-.97; P = .046). Use of this assay as an additional tool for managing allo-HCT recipients at risk for CMV reactivation needs further validation in future studies. Application of this new approach may reduce the duration and intensity of CMV monitoring and the duration of prophylaxis or treatment with antiviral agents in those who have achieved CMV-specific immune reconstitution.
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Lior
authors.initials: L
authors.lastname: Nesher
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Dimpy P
authors.initials: DP
authors.lastname: Shah
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Ella J
authors.initials: EJ
authors.lastname: Ariza-Heredia
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Jacques M
authors.initials: JM
authors.lastname: Azzi
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Hala K
authors.initials: HK
authors.lastname: Siddiqui
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Shasank S
authors.initials: SS
authors.lastname: Ghantoji
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Lisa Y
authors.initials: LY
authors.lastname: Marsh
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Lamprinos
authors.initials: L
authors.lastname: Michailidis
authors.affiliation: Center for Human Immunobiology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas.
authors.forename: George
authors.initials: G
authors.lastname: Makedonas
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center.
authors.forename: Katy
authors.initials: K
authors.lastname: Rezvani
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, University of Texas MD Anderson Cancer Center.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Shpall
authors.affiliation: Department of Infectious Diseases, Infection Control, and Employee Health.
authors.forename: Roy F
authors.initials: RF
authors.lastname: Chemaly
mesh_terms: D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000150:complications / Q000175:diagnosis*; D058501:Enzyme-Linked Immunospot Assay; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007371:Interferon-gamma / Q000097:blood; D059425:Interferon-gamma Release Tests; D007938:Leukemia / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D018570:Risk Assessment; D013601:T-Lymphocytes / Q000276:immunology; D066027:Transplant Recipients; D055815:Young Adult
chemical_list: D015415:Biomarkers; D007371:Interferon-gamma
keywords: ELISPOT; IGRA; bone marrow transplant; cytomegalovirus; stem cell transplant