Objective: To evaluate the utility of plasma CMV-PCR to guide anti-CMV pre-emptive therapy.
Methods: We analyzed 89 Allogeneic hematologic stem cell transplantation (allo-HSCT) patients with plasma CMV-DNA positive after HSCT. From the day of HSCT, plasma CMV-DNA were monitored weekly(CMV 4 degrees C PCR kits), and 52 cases were chosen randomisely to receive pre-emptive therapy. The 89 patients were divided into three groups: patients without pre-emptive therapy, patients with plasma CMV-DNA remaining positive after pre-emptive therapy, and patients with plasma CMV-DNA turning to negative after pre-emptive therapy. Kaplan-Meier curve differences were compared by Log-Rank or Breslow test, RXC tables or chi 2 tests were used to compare the incidence of CMV disease.
Results: The accumulative incidence of CMV disease within the first 100 days after HSCT was 36.24% among the PV-PCR (CMV-PCR) positive patients without pre-emptive therapy, 66.67% among the patients with PV-PCR remaining positive after pre-emptive therapy, and 10.26% among the patients with PV-PCR turning to be negative after pre-emptive therapy respectively (P = 0.0000). The incidence of CMV disease 100 days post HSCT between any two groups was different. The accumulative incidence of CMV disease 1 year after HSCT was 42.95%, 75.00% and 30.65%, respectively among the above three groups (P = 0.0009). The incidence of CMV disease in 1 year among patients with PV-PCR remaining positive after pre-emptive treatment was higher than the others.
Conclusion: PV-PCR guided pre-emptive therapy may decrease the incidence of CMV disease within 100 days after HSCT, and patients with PV-PCR remaining positive after pre-emptive therapy may need a combined treatment.