Diagnostic usefulness of dynamic changes of CMV-specific T-cell responses in predicting CMV infections in HCT recipients

作者：Jung Jiwon; Lee Hyun Jung; Kim Sun Mi; Kang Young Ah; Lee Young Shin; Chong Yong Pil; Sung Heungsup; Lee Sang Oh; Choi Sang Ho; Kim Yang Soo; Woo Jun Hee; Lee Jung Hee; Lee Je Hwan; Lee Kyoo Hyung; Kim Sung Han^*

来源：Journal of Clinical Virology, 2017, 87: 5-11.

DOI：10.1016/j.jcv.2016.11.012

• Cytomegalovirus
• Hematopoietic stem cell transplantation
• ELISPOT

Background: CMV-specific cell mediated immune responses before and after hematopoietic stem cell transplantation (HCT) can categorize patients as at high or low risk of CMV development.
Objectives: We evaluated the usefulness of the CMV-specific T-cell ELISPOT assay for predicting the development of CMV infections after HCT in recipients with donor-positive and recipient-positive CMV serology (D+/R+).
Study design: CMV pp65 and IE1-specific ELISPOT assays were performed before HCT (DO), and at 30 (D30) and 90 (D90) days after HCT.
Results: Of the 84 HCT recipients with D+/R+, 42 (50%) developed > 1 episode of CMV infection. Thirtynine (64%) of 61 patients with Delta(D30-DO) pp65 <42 developed CMV infections compared with 3 (14%) of 21 patients with Delta(D30-DO) pp65 > 42 (P < 0.001). Twenty-three (74%) of 31 patients with A(D30-DO) IE1 < -4 developed CMV infections compared with 19 (37%) of 51 patients with Delta(D30-DO) IE1 >= -4 (P = 0.001). pp65 Delta(D30-DO) > 42 had 93% sensitivity for ruling out subsequent CMV infection, and pp65 Delta(D30-DO)< 42 followed by Delta(D30-DO) IE1 <-4 had 100% specificity for ruling in the subsequent CMV infection. In addition, 10 (53%) of 19 patients with Delta(D90-D30) pp65 < 23 had relapsing CMV infections, compared with 3 (15%) of 20 patients with Delta(D90-D30) pp65 >= 23 (P = 0.02). The sensitivity and specificity of Delta(D90-D30) pp65 were 77% (95% CI 50-92) and 65% (95% CI, 46-81).
Conclusion: Dynamic change in the CMV-specific ELISPOT assay before versus after HCT appears to predict the subsequent development of CMV infection and relapsing CMV infection.

• 出版日期2017-2