Surveillance of cytomegalovirus infection in haematopoietic stem cell transplantation patients

J Infect. 2005 Feb;50(2):130-7. doi: 10.1016/j.jinf.2003.11.010.

Abstract

Objectives: The aim of this study was to describe our experience in the control of active CMV infection following HSCT using two strategies of CMV infection treatment: ganciclovir universal prophylaxis at low doses and pre-emptive therapy with ganciclovir.

Methods: The surveillance was based on the monitoring of antigenaemia (AGM) and on a nested polymerase chain reaction (N-PCR) for the detection of CMV in both strategies. Forty-five recipients with malignant diseases and with a risk for CMV disease received universal prophylaxis (Group A). The non-treated group consisted of 24 patients, most of them with non-malignant diseases who did not receive universal prophylaxis (Group B).

Results: In Group A, the incidence of positive AGM was 51%, with a positive PCR of 68.9%. In Group B, the AGM positivity was 66.7% and that of N-PCR was 66.7%. CMV disease occurred in 6/55 patients (10.9%), with 2/36 (5.5%) from Group A and 4/19 (21%) from Group B. Two of these six patients (33.3%) died of CMV disease.

Conclusions: Our result suggests that AGM and N-PCR can be used as markers for assessing the monitoring and the introduction pre-emptive therapy. This approach could prove to be more cost-effective than ganciclovir universal prophylaxis for treating CMV infection.

MeSH terms

  • Adolescent
  • Adult
  • Antiviral Agents / therapeutic use*
  • Child
  • Child, Preschool
  • Cytomegalovirus / genetics
  • Cytomegalovirus / isolation & purification*
  • Cytomegalovirus Infections / epidemiology
  • Cytomegalovirus Infections / prevention & control*
  • Female
  • Ganciclovir / therapeutic use*
  • Hematopoietic Stem Cell Transplantation / adverse effects*
  • Humans
  • Incidence
  • Male
  • Middle Aged
  • Phosphoproteins / blood
  • Polymerase Chain Reaction
  • Population Surveillance*
  • Viral Matrix Proteins / blood

Substances

  • Antiviral Agents
  • Phosphoproteins
  • Viral Matrix Proteins
  • cytomegalovirus matrix protein 65kDa
  • Ganciclovir