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Transplantation
Standardized monitoring of cytomegalovirus- specific immunity can improve risk stratifica- tion of recurrent cytomegalovirus reactivation after hematopoietic stem cell transplantation
Ferrata Storti Foundation
Haematologica 2021 Volume 106(2):363-374
Eva Wagner-Drouet,1,* Daniel Teschner,1,* Christine Wolschke,2 Dietlinde Janson,2 Kerstin Schäfer-Eckart,3 Johannes Gärtner,3 Stephan Mielke,4,5 Martin Schreder,4,§ Guido Kobbe,6 Mustafa Kondakci,6 Inken Hilgendorf,7 Marie von Lilienfeld-Toal,7 Stefan Klein,8 Daniela Heidenreich,8 Sebastian Kreil,8 Mareike Verbeek,9 Sandra Graß,9 Markus Ditschkowski,10 Tanja Gromke,10 Martina Koch,11,‡ Monika Lindemann,12 Thomas Hünig,13 Traudel Schmidt,14 Anne Rascle,14 Harald Guldan,14 Sascha Barabas,14 Ludwig Deml,14 Ralf Wagner14,15 and Daniel Wolff16
1Department of Hematology, Medical Oncology, and Pneumology, University Medical Center of the Johannes Gutenberg University, Mainz, Germany; 2Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Germany; 3Oncology, Hematology and Bone Marrow Transplantation Unit, Klinikum Nord, Nürnberg, Germany; 4Department of Medicine II, University Medical Center, Würzburg, Germany; 5Department of Laboratory Medicine, CAST, Karolinska Institutet and University Hospital, Stockholm, Sweden; 6Department of Hematology, University Hospital Düsseldorf, Medical Faculty, Heinrich Heine University, Düsseldorf, Germany; 7Klinik für Innere Medizin II, Abteilung für Hämatologie und Internistische Onkologie, Universitätsklinikum, Jena, Germany; 8Department of Hematology and Oncology, UMM University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany; 9III Medical Department, Hematology and Oncology, Klinikum Rechts der Isar, Technical University, Munich, Germany; 10Innere Klinik, Tumorforschung, University Hospital Essen, Germany; 11Department of Hepatobiliary Surgery and Transplantation, University Medical Center Hamburg-Eppendorf, Germany; 12Institute for Transfusion Medicine, University Hospital, Essen, Germany; 13Institute of Virology and Immunobiology, University Medical Center, Würzburg, Germany; 14Lophius Biosciences, Regensburg, Germany; 15Institute of Clinical Microbiology and Hygiene, University Medical Center Regensburg, Germany and 16Department of Internal Medicine III, Hematology and Oncology, University Medical Center Regensburg, Germany.
*EW-D and DT contributed equally as co-first authors.
§Current address: First Department of Medicine, Center for Oncology and Hematology, Wilhelminenspital, Vienna, Austria
‡Current address: Department of General, Visceral and Transplantation Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
ABSTRACT
Recurrence of cytomegalovirus reactivation remains a major cause of morbidity and mortality following allogeneic hematopoietic stem cell transplantation. Monitoring cytomegalovirus-specific cel- lular immunity using a standardized assay might improve the risk strati- fication of patients. A prospective multicenter study was conducted in 175 intermediate- and high-risk allogeneic hematopoietic stem cell trans- plant recipients under preemptive antiviral therapy. Cytomegalovirus- specific cellular immunity was measured using a standardized interferon- γ enzyme-linked immunospot assay (T-Track® CMV). The primary aim was to evaluate the suitability of measuring cytomegalovirus-specific immunity after the end of treatment for a first cytomegalovirus reactiva- tion to predict recurrent reactivation. Forty of 101 (39.6%) patients with a first cytomegalovirus reactivation experienced recurrent reactivations, mainly in the high-risk group (cytomegalovirus-seronegative donor/cytomegalovirus-seropositive recipient). The positive predictive value of T-Track® CMV (patients with a negative test after the first reac- tivation who experienced at least one recurrent reactivation) was 84.2% in high-risk patients. Kaplan-Meier analysis revealed a higher probability of recurrent cytomegalovirus reactivation in high-risk patients with a
Correspondence:
DANIEL WOLFF
daniel.wolff@ukr.de
RALF WAGNER
ralf.wagner@ukr.de
Received: June 10, 2019. Accepted: December 18, 2019. Pre-published: December 26, 2019.
https://doi.org/10.3324/haematol.2019.229252
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