Cytomegalovirus DNA Doubling Time for Early Identification of Clinically Significant Infection Episodes in Allogeneic Hematopoietic Stem Cell Transplant Recipients Undergoing Primary Letermovir Prophylaxis: A Multicenter Study.
Estela Giménez, Irene García Cadenas, José Luis Piñana, Eliseo Albert, Lourdes Vázquez, Alejandro Avendaño, Mónica Cabrero, Albert Esquirol, Rodrigo Martino, Javier López-Jiménez, María Ángeles Cuesta, Karem Humala, Sara Villar, Montserrat Rovira, Inmaculada Heras, Teresa Zudaire, Ignacio Arroyo, Amaya Zabalza, Beatriz Aguado, Carlos Solano, David Navarro
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引用次数: 0
Abstract
Background: Letermovir (LMV) prophylaxis currently represents the first-line strategy for preventing clinically significant cytomegalovirus (CMV) infection (CsCMVi) in CMV-seropositive recipients of allogeneic hematopoietic stem cell transplantation (allo-HSCT). A wide variety of CMV DNA thresholds for LMV interruption and preemptive antiviral therapy (PET) inception are in place across transplantation centers.
Methods: We evaluated the potential of CMV DNA doubling time (dt) in plasma to distinguish between CsCMVi and abortive CMV infection in allo-HSCT recipients on primary LMV prophylaxis. Data from the Spanish Hematopoietic Transplantation and Cell Therapy Group multicenter registry included 296 allo-HSCT patients receiving LMV prophylaxis. Participating centers used a plasma CMV DNA threshold of ≥1000 IU/mL for initiating PET. The CMV DNA dt was calculated from the first two or three positive polymerase chain reaction (PCR) results based on pre-established criteria.
Results: CMV DNAemia developed in 64 recipients (21.6%) with a total of 88 episodes, of which CsCMVi occurred in 9 recipients (3.04%) and included 10 episodes (one patient had confirmed CMV gastrointestinal disease). A non-calculable CMV DNA dt had a negative predictive value of 94% for CsCMVi. For initial episodes with calculable CMV DNA dts (4/7 CsCMVi and 8/57 no-CsCMVi), a threshold of >2.35 days had a specificity of 100% for ruling out CsCMVi.
Conclusion: CMV DNA dt could optimize CMV infection management in allo-HSCT patients under LMV prophylaxis, independent of the PCR platform used.
背景:Letermovir (LMV)预防目前是预防巨细胞病毒(CMV)血清阳性的同种异体造血干细胞移植(alloo - hsct)受者临床显著巨细胞病毒(CMV)感染(CsCMVi)的一线策略。在移植中心,各种各样的CMV DNA阈值用于LMV中断和先发制人的抗病毒治疗(PET)的开始。方法:我们评估了血浆中巨细胞病毒DNA倍增时间(dt)的潜力,以区分初次预防LMV的同种异体造血干细胞移植受者的CsCMVi和流产巨细胞病毒感染。来自西班牙造血移植和细胞治疗组多中心注册的数据包括296例接受LMV预防的同种异体造血干细胞移植患者。参与中心使用血浆CMV DNA阈值≥1000 IU/mL启动PET。根据预先建立的标准,从前两个或三个聚合酶链反应(PCR)阳性结果计算CMV DNA dt。结果:64例(21.6%)受者发生CMV dna血症,共88次发作,其中9例(3.04%)发生CsCMVi,包括10次发作(1例确诊CMV胃肠道疾病)。不可计算的CMV DNA dt对CsCMVi的阴性预测值为94%。对于可计算的CMV DNA dts的初始发作(4/7 CsCMVi和8/57无CsCMVi), bbb2.35天的阈值对排除CsCMVi的特异性为100%。结论:CMV DNA dt可以优化LMV预防的同种异体造血移植患者的CMV感染管理,与使用的PCR平台无关。
期刊介绍:
Transplant Infectious Disease has been established as a forum for presenting the most current information on the prevention and treatment of infection complicating organ and bone marrow transplantation. The point of view of the journal is that infection and allograft rejection (or graft-versus-host disease) are closely intertwined, and that advances in one area will have immediate consequences on the other. The interaction of the transplant recipient with potential microbial invaders, the impact of immunosuppressive strategies on this interaction, and the effects of cytokines, growth factors, and chemokines liberated during the course of infections, rejection, or graft-versus-host disease are central to the interests and mission of this journal.
Transplant Infectious Disease is aimed at disseminating the latest information relevant to the infectious disease complications of transplantation to clinicians and scientists involved in bone marrow, kidney, liver, heart, lung, intestinal, and pancreatic transplantation. The infectious disease consequences and concerns regarding innovative transplant strategies, from novel immunosuppressive agents to xenotransplantation, are very much a concern of this journal. In addition, this journal feels a particular responsibility to inform primary care practitioners in the community, who increasingly are sharing the responsibility for the care of these patients, of the special considerations regarding the prevention and treatment of infection in transplant recipients. As exemplified by the international editorial board, articles are sought throughout the world that address both general issues and those of a more restricted geographic import.