Clinical significance of cytomegalovirus (CMV) antigenemia in the prediction and diagnosis of CMV gastrointestinal disease after allogeneic hematopoietic stem cell transplantation

Mori, Takehiko; Mori, Shin Ichiro; Kanda, Yoshinobu; Yakushiji, Kazuaki; Mineishi, Shin; Takaue, Yoichi; Gondo, Hisashi; Harada, Mine; Sakamaki, Hisashi; Yajima, Tomoharu; Iwao, Yasushi; Hibi, Toshifumi; Okamoto, Shinichiro

doi:10.1038/sj.bmt.1704369

Cited by 103 publications

(65 citation statements)

References 16 publications

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“…A higher rate of negative pp65Ag screening tests compared with quantPCR have been reported in cases of CMV colitis, retinitis or other localised non-pulmonary sites of CMV-D. 13,14,33,34 In fact, an advantage in preventing GI CMV-D has been reported with PCR screening techniques in comparison to antigenemia testing. 35 However, as most cases of CMV pneumonia with prior negative screening tests occurred during the pp65Ag screening period in this study, molecular screening methods could offer higher sensitivity over pp65Ag in detecting CMV replication before the occurrence of CMV pneumonia. Nonetheless, this study has important methodological limitations, which are mainly a consequence of its retrospective design.…”

Section: Discussionmentioning

confidence: 99%

Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience

Piñana

Martino

Barba

et al. 2009

Bone Marrow Transplant

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The aim of this study was to analyse the incidence and risk factors for cytomegalovirus infection (CMV-I) and disease (CMV-D) after a reduced intensity conditioning allogeneic hematopoietic stem cell transplantation (alloHSCT-RIC). We included 186 consecutive alloHSCT-RIC adult patients at risk for CMV reactivation (patient and/or donor CMV seropositivity). Conditioning regimen was based on fludarabine plus an alkylating agent. For guiding pre-emptive anti-CMV therapy, Pp65 Antigenemia (pp65Ag) (n ¼ 116) or quantitative polymerase chain reaction (quantPCR) (n ¼ 70) were used. The 2-year incidence of CMV-I and/or CMV-D was 36% (11% for CMV-D). Of note, 12/14 (86%) episodes of CMV-D in the pp65Ag group had lung involvement compared with only 3/ 15 (20%) in the quantPCR group (P ¼ 0.01). Importantly, the number of patients who developed CMV pneumonia with prior negative screening tests was unusually high (67% overall). Multivariate analysis of risk factors for CMV-D identified two risk factors: (i) steroid therapy for moderateto-severe graft-vs-host disease (GVHD) (hazard ratio 4.7, P ¼ 0.02); and (ii) alternative donors (non-HLA-identical siblings) [hazard ratio 2.7, P ¼ 0.002]. Our findings suggest that CMV is still a major concern in alloHSCT-RIC. Variables associated with poor anti-CMV T-cell recovery (that is, GVHD and donor type) are helpful in identifying patients at higher risk for CMV-D in the alloHSCT-RIC setting.

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Section: Discussionmentioning

confidence: 99%

Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience

Piñana

Martino

Barba

et al. 2009

Bone Marrow Transplant

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“…However the role of these tests in detecting CMV infection before the onset of CMV gastro-intestinal disease is not conclusive. [12] Furthermore, as in our case, some cases of compartmentalized or localized CMV diseases have very low or transient periods of viremia. [13,14] On the other hand, follow-up viral load testing is useful when the decision is made to initiate treatment, testing of the viral load should be performed the day the therapy starts, followed by viral load testing with 5-to 7-day intervals, because the half-life of CMV DNA in the plasma ranges from 3 to 8 days.…”

Section: Discussionmentioning

confidence: 99%

A rare case of cytomegalovirus presentation in a hemodialysis patient

Waele

Wierckx

Bogaert³

2017

CRIM

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Background: Cytomegalovirus (CMV) infection is a common viral infection in humans with a diverse manifestation, mostly dependent on the host. CMV infection in the immunocompetent host is generally asymptomatic or may present as a mononucleosis syndrome. Infection in immunocompromised patients cause substantial morbidity and mortality. Case representation: We report a rare manifestation of a CMV infection in a 87-year-old male with end-stage renal failure with dialysis dependency and diabetes who presents with diffuse abdominal pain and nausea. Further assessment with a CT scan of the abdomen showed a thickening of the wall of the preterminal ileum, suggestive of focal enteritis. Ileocolonoscopy showed a partial circular ulcerated mucosa of the preterminal ileum, biopsies showed ulcerations, etiology was unknown. A few days later he develops melena and anemia of 7.2 g/dl. Further exploration with gastroscopy was normal. A new colonoscopy showed no abnormalities; however the terminal ileum could not be visualized. An urgent laparotomy was performed because of hemodynamic instability and showed an ulcus of 7 cm with a thickened terminal ileum. An enterectomy of the inflammated part of the ileum was performed. Histopathology of the ulceration showed the presence of CMV inclusions in the vascular endothelium of the capillaires of the ileal segment. Serologic examination showed nonreactive CMV IgM antibodies and IgG antibodies were positive. PCR CMV showed 300 copies/ml (whole blood). Treatment with intravenous ganciclovir was started with good clinical and biochemical response. Conclusions: In the differential diagnosis CMV disease should be considered in any ulceration in the gastro-intestinal tract in the immunocompromised patient.

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“…The antigenemia assay is one of the most widely used methods for detecting reactivation of CMV infection, but only a few studies have examined its diagnostic value for CMV-GID, [18][19][20][21] and all were retrospective in design. Jang et al 20 recently reported that the sensitivity and specificity of the CMV antigenemia assay for the diagnosis of CMV-GID were 54% and 88%, respectively, in patients with secondary immunodeficiency disease.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Antigenemia Assay for the Diagnosis of Cytomegalovirus Gastrointestinal Diseases in HIV-Infected Patients

Hamada

Nagata

Shimbo

et al. 2013

AIDS Patient Care and STDs

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We conducted a single-center prospective study to evaluate the utility of cytomegalovirus (CMV) antigenemia assay for the diagnosis of CMV-gastrointestinal disease (GID). The study subjects were HIV-infected patients with CD4 count £ 200 lL/cells who had undergone endoscopy. A definite diagnosis of CMV-GID was made by histological examination of endoscopic biopsied specimen. CMV antigenemia assay (C10/C11 monoclonal antibodies), CD4 count, HIV viral load, history of HAART, and gastrointestinal symptoms as measured by 7-point Likert scale, were assessed on the same day of endoscopy. One hundred cases were selected for analysis, which were derived from 110 cases assessed as at high-risk for CMV-GID after endoscopy screening of 423 patients. Twelve patients were diagnosed with CMV-GID. Among the gastrointestinal symptoms, mean bloody stool score was significantly higher in patients with CMV-GID than in those without (2.5 vs. 1.7, p = 0.02). The area under the receiver-operating characteristic curve of antigenemia was 0.80 (95%CI 0.64-0.96). The sensitivity, specificity, positive likelihood ratio (LR), and negative LR of antigenemia were 75.0%, 79.5%, 3.7, and 0.31, respectively, when the cutoff value for antigenemia was ‡ 1 positive cell per 300,000 granulocytes, and 50%, 92.0%, 5.5, and 0.55, respectively, for ‡ 5 positive cells per 300,000 granulocytes. In conclusion, CMV antigenemia seems a useful diagnostic test for CMV-GID in patients with HIV infection. The use of ‡ 5 positive cells per 300,000 granulocytes as a cutoff value was associated with high specificity and high positive LR. Thus, a positive antigenemia assay with positive endoscopic findings should allow the diagnosis of CMV-GID without biopsy.

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Clinical significance of cytomegalovirus (CMV) antigenemia in the prediction and diagnosis of CMV gastrointestinal disease after allogeneic hematopoietic stem cell transplantation

Cited by 103 publications

References 16 publications

Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience

Cytomegalovirus infection and disease after reduced intensity conditioning allogeneic stem cell transplantation: single-centre experience

A rare case of cytomegalovirus presentation in a hemodialysis patient

Assessment of Antigenemia Assay for the Diagnosis of Cytomegalovirus Gastrointestinal Diseases in HIV-Infected Patients

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