Ann Lab Med.  2017 May;37(3):277-281. 10.3343/alm.2017.37.3.277.

Clinical Usefulness of Monitoring Cytomegalovirus-Specific Immunity by Quantiferon-CMV in Pediatric Allogeneic Hematopoietic Stem Cell Transplantation Recipients

• Lee SM
• Kim YJ
• Yoo KH
• Sung KW
• Koo HH
• Kang ES

• KMID: 2369755
• DOI: http://doi.org/10.3343/alm.2017.37.3.277

Abstract

Cytomegalovirus (CMV) is a well-established cause of morbidity and mortality in pediatric recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). CD8⁺ T-cells are important for controlling CMV infection. We conducted a prospective pilot study to investigate the clinical utility of measuring the CMV-specific T-cell immune response using the QuantiFERON-CMV assay (QF-CMV) in pediatric allo-HSCT recipients. Overall, 16 of 25 (64%) patients developed CMV infection. QF-CMV was evaluated in these 16 patients during the early and late phases of the first CMV infection post allo-HSCT. Whereas the initial QF-CMV results during the early phase of CMV infection did not correlate with the course of the corresponding infection, the QF-CMV results post resolution of the first CMV infection correlated with the recurrence of CMV infection until 12 months post allo-HSCT; no recurrent infections occurred in the four QF-CMV-positive patients, while recurrent infections manifested in five of eight QF-CMV-negative (62.5%) and all three QF-CMV-indeterminate patients (P=0.019). In spite of the small number of patients examined, this study supports the potential application of monitoring CMV-specific T-cell immunity using the QF-CMV assay to predict the recurrence of CMV infection in pediatric allo-HSCT recipients.

Keyword

Cytomegalovirus; T-cell immunity; Pediatric hematopoietic stem cell transplantation; Quantiferon-CMV

MeSH Terms

Cytomegalovirus
Hematopoietic Stem Cell Transplantation*
Hematopoietic Stem Cells*
Humans
Mortality
Pilot Projects
Prospective Studies
Recurrence
T-Lymphocytes

Figure

• 

  Fig. 1 The longitudinal patterns of CMV pp65 antigenemia and CMV-specific T-cell response measured by using the QuantiFERON-CMV assay in three allogeneic HSCT recipients. (A) Nine-year-old female patient with aplastic anemia with repeated positive QuantiFERON-CMV assay results during the early phase of CMV infection. (B) Eleven-month-old male patient with juvenile myelomonocytic leukemia who converted from indeterminate and negative to positive QuantiFERON-CMV results during the course of infection. (C) Twenty-eight-month-old female patient with neuroblastoma with persistent negative results, except for a single positive result during the early transplant phase; the patient died because of tumor progression at 140 days post HSCT. ‘+’ indicates a positive QF-CMV result, ‘-’ indicates a negative result, and ‘♦’ indicates an indeterminate result.Abbreviations: CMV, cytomegalovirus; HSCT, hematopoietic stem cell transplantation; WBCs, white blood cells.

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