Journal Article

Monitoring of Human Cytomegalovirus and Virus-Specific T-Cell Response in Young Patients Receiving Allogeneic Hematopoietic Stem Cell Transplantation

Gerna, Giuseppe, Locatelli, Franco, Lilleri, Daniele, Chiesa, Antonella, Zecca, Marco, Mastronuzzi, Angela, Zelini, Paola, Rognoni, Vanina, Giorgiani, Giovanna

2012

Overview

In allogeneic hematopoietic stem-cell transplantation (HSCT) recipients, outcome of human cytomegalovirus (HCMV) infection results from balance between viral load/replication and pathogen-specific T-cell response. Using a cut-off of 30,000 HCMV DNA copies/ml blood for pre-emptive therapy and cut-offs of 1 and 3 virus-specific CD4(+) and CD8(+) T cells/µl blood for T-cell protection, we conducted in 131 young patients a prospective 3-year study aimed at verifying whether achievement of such immunological cut-offs protects from HCMV disease. In the first three months after transplantation, 55/89 (62%) HCMV-seropositive patients had infection and 36/55 (65%) were treated pre-emptively, whereas only 7/42 (17%) HCMV-seronegative patients developed infection and 3/7 (43%) were treated. After 12 months, 76 HCMV-seropositive and 9 HCMV-seronegative patients (cumulative incidence: 90% and 21%, respectively) displayed protective HCMV-specific immunity. Eighty of these 85 (95%) patients showed spontaneous control of HCMV infection without additional treatment. Five patients after reaching protective T-cell levels needed pre-emptive therapy, because they developed graft-versus-host disease (GvHD). HSCT recipients reconstituting protective levels of HCMV-specific T-cells in the absence of GvHD are no longer at risk for HCMV disease, at least within 3 years after transplantation. The decision to treat HCMV infection in young HSCT recipients may be taken by combining virological and immunological findings.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adolescent / Binomial distribution / Biology / Blood / Care and treatment / CD4 antigen / CD8 antigen / Child / Child, Preschool / Cytokines / Cytomegalovirus / Cytomegalovirus - immunology / Cytomegalovirus - physiology / Cytomegalovirus infections / Cytomegalovirus Infections - etiology / Cytomegalovirus Infections - immunology / Deoxyribonucleic acid / Development and progression / Disease susceptibility / DNA / Female / Graft-versus-host reaction / Health aspects / Health risks / Hematopoietic stem cell transplantation / Hematopoietic Stem Cell Transplantation - adverse effects / Hematopoietic stem cells / Humans / Immunity / Immunology / Infant / Infection / Infections / Lymphocytes / Lymphocytes T / Male / Medical research / Medicine / Patients / Species Specificity / Stem cell transplantation / Stem cells / T cell receptors / T cells / T-Lymphocytes - immunology / Therapy / Transplantation / Transplantation, Homologous - adverse effects / Transplants & implants / Viral infections / Viruses / Young Adult