Monitoring of trough plasma ganciclovir levels and peripheral blood cytomegalovirus (CMV)-specific CD8+ T cells to predict CMV DNAemia clearance in preemptively treated allogeneic stem cell transplant recipients

Estela Giménez; Carlos Solano; José Ramón Azanza; Paula Amat; David Navarro

doi:10.1128/AAC.02953-14

Monitoring of trough plasma ganciclovir levels and peripheral blood cytomegalovirus (CMV)-specific CD8+ T cells to predict CMV DNAemia clearance in preemptively treated allogeneic stem cell transplant recipients

Antimicrob Agents Chemother. 2014 Sep;58(9):5602-5. doi: 10.1128/AAC.02953-14. Epub 2014 Jun 30.

Authors

Estela Giménez¹, Carlos Solano², José Ramón Azanza³, Paula Amat⁴, David Navarro⁵

Affiliations

¹ Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain.
² Hematology and Medical Oncology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.
³ Clinic Pharmacology Service, Clínica Universidad de Navarra, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain.
⁴ Hematology and Medical Oncology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain.
⁵ Microbiology Service, Hospital Clínico Universitario, Fundación INCLIVA, Valencia, Spain Department of Microbiology, School of Medicine, University of Valencia, Valencia, Spain [email protected].

Abstract

It is uncertain whether monitoring plasma ganciclovir (GCV) levels is useful in predicting cytomegalovirus (CMV) DNAemia clearance in preemptively treated allogeneic stem cell transplant recipients. In this observational study, including 13 episodes of CMV DNAemia treated with intravenous (i.v.) GCV or oral valganciclovir, we showed that monitoring trough plasma GCV levels does not reliably predict response to therapy. Rather, immunological monitoring (pp65 and immediate-early [IE]-1-specific gamma interferon [IFN-γ]-producing CD8+ T cells) appeared to perform better for this purpose.

Publication types

Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Anemia, Aplastic / surgery
CD8-Positive T-Lymphocytes / immunology
Cytomegalovirus / drug effects
Cytomegalovirus / immunology
Cytomegalovirus Infections / drug therapy*
Cytomegalovirus Infections / immunology
Cytomegalovirus Infections / virology
DNA, Viral / blood
Female
Ganciclovir / analogs & derivatives*
Ganciclovir / blood*
Ganciclovir / therapeutic use*
Humans
Interferon-gamma / blood
Leukemia, Myeloid, Acute / surgery
Lymphoma, Non-Hodgkin / surgery
Male
Middle Aged
Multiple Myeloma / surgery
Phosphoproteins / blood
Precursor Cell Lymphoblastic Leukemia-Lymphoma / surgery
Stem Cell Transplantation*
Transplant Recipients
Valganciclovir
Viral Matrix Proteins / blood

Substances

DNA, Viral
Phosphoproteins
Viral Matrix Proteins
pp67 protein, human cytomegalovirus
Interferon-gamma
Valganciclovir
Ganciclovir