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Cytomegalovirus (CMV) Cell-Mediated Immunity and CMV Infection After Allogeneic Hematopoietic Cell Transplantation: The REACT Study
- Chemaly, RF (author)
- El Haddad, L (author)
- Winston, DJ (author)
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- Rowley, SD (author)
- Mulane, KM (author)
- Chandrasekar, P (author)
- Avery, RK (author)
- Hari, P (author)
- Peggs, KS (author)
- Kumar, D (author)
- Nath, R (author)
- Mossad, SB (author)
- Dadwal, SS (author)
- Blanchard, T (author)
- Shah, DP (author)
- Jiang, Y (author)
- Ariza-Heredia, E (author)
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- (creator_code:org_t)
- 2020-02-20
- 2020
- English.
- In: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. - : Oxford University Press (OUP). - 1537-6591. ; 71:9, s. 2365-2374
- Journal article (peer-reviewed)
Abstract
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- BackgroundCytomegalovirus (CMV) infection remains an important cause of morbidity and mortality in allogeneic hematopoietic cell transplant (allo-HCT) recipients. CMV cell-mediated immunity (CMV-CMI) as determined by a peptide-based enzyme-linked immunospot (ELISPOT) CMV assay may identify patients at risk for clinically significant CMV infection (CS-CMVi).MethodsThe CS-CMVi was defined as CMV viremia and/or disease necessitating antiviral therapy. CMV-CMI was characterized as high when the intermediate-early 1 (IE-1) antigen spot counts (SPCs) were >100 (cutoff 1) or when the IE-1 and phosphoprotein 65 antigen SPCs were both >100 SPCs per 250 000 cells (cutoff 2), and a low CMV-CMI when SPCs were below these thresholds. In this prospective multicenter study, we evaluated CMV-CMI every 2 weeks from the pretransplant period until 6 months posttransplantation in 241 allo-HCT recipients with positive CMV serostatus. The primary endpoint was CS-CMVi occurring within 2 weeks of the last measurement of CMV-CMI.ResultsCS-CMVi occurred in 70 allo-HCT recipients (29%). CMV-CMI was low in patients who experienced CS-CMVi (94%), whereas those who had a high CMV-CMI were less likely to have CS-CMVi (P < .0001). Patients with CS-CMVi had higher all-cause mortality (P = .007), especially those with low CMV-CMI (P = .035). On multivariable analysis, CMV-CMI, sex, race, antithymocyte globulin, and steroid use were independent predictors of CS-CMVi, and the time from transplant to engraftment was the only predictor of mortality.ConclusionsMeasurement of CMV-CMI using a novel ELISPOT assay would be useful clinically to monitor allo-HCT recipients and distinguish between those at risk of developing CS-CMVi and requiring antiviral prophylaxis or therapy and those who are protected.
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- Chemaly, RF
- El Haddad, L
- Winston, DJ
- Rowley, SD
- Mulane, KM
- Chandrasekar, P
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- Avery, RK
- Hari, P
- Peggs, KS
- Kumar, D
- Nath, R
- Ljungman, P
- Mossad, SB
- Dadwal, SS
- Blanchard, T
- Shah, DP
- Jiang, Y
- Ariza-Heredia, E
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