Monitoring The Cytomegalovirus Infection In Hematopoietic Stem Cell Transplant Recipients

Objective Mornitoring cytomegalovirus PP65 antigenemia and DNA in Hematopoietic stem cell transplant recipients, to invest the occurrence of the CMV infection and recurrent before day 100, after day 100, especially during the period of antivirus therapy. At the same time to discuss the patterns of CMV infection during both periods. It may be useful in CMV infection' s diagnosis and treatment.Methods A total of 245 EDTA anticoagulant blood samples from 9 HSCT patients were prospectively collected from August 2001 to Feburary 2003. Peripheral blood leukocytes were isolated from blood samples and were detected weekly after HSCT until 100 days by PP65 antigenemia assay , after that , they were detected every two weeks or every one month until death , out of the study or the deadline of the study. Cytomegalovirus DNA in PBL and plasma were detected by nested polymerase chain reaction simultaneously.Ganciclovir preemptive therapy was initiated at a level of 5 positive cells per 50000 leukocytes; discontinuation after 7-14 days after negative antigenemia assay; repeated treatment if antigenemia recurred. Results Monitoring results of PP65 antigenemia and nested PCR:Before day 100 after HSCT,all the patients occurred active CMV infection, but after treatment, no cases developed CMV disease. PP65 antigenemia was found in 41 out of 121 samples , and the level ranged from 0-21/5×104. CMV DNA was observed in 25 out of 121 plasma samples and 61 out of 121 leukocyte samples by n-PCR. Later than 100 days after HSCT, PP65 antigenemia was found in 76 out of 124 samples, and the levels ranged from O-59/5×104.CMV DNA was observed in 18 out of 124 plasma samples and 34 out of 124 leukocyte samples.Patterns of CMV detection by PP65 antigenemia assay and nested PCR : before day 100:1) Pattern one: The markers of CMV infection was detectable first in leukocyte followed in plasma by n-PCR, then in leukocyte by PP65 antigenemia assay. 2)The second pattern :Firstly, CMV DNA was detectable in leukocyte but not in plasma . Then low-grade PP65 antigenemia occurred. 3)The third pattern consisted of isolated CMV DNA positivity in plasma then low-grade antigenemia without CMV DNA positivity in leukocyte. After day 100:1)Pattern one:detecting CMV DNA in plasma with high-grade PP65 antigenemia without CMV DNA positivity in leukocyte. 2)The second pattern:plasma and leukocyte samples were detectable CMV DNA alternately with high-grade PP65 antigenemia. After the start of treatment, even if the CMV-Ag is negative, sporadic positive test results were still detected in plasma or leukocyte. 2)Detecting CMV DNA in leukocyte , with low-grade PP65 antigenemia. CMV DNA was not detectable in plasma all along.Conclusions In conclusion , all the patients occurred active CMV infection before day 100 and after day 100. Observing three CMV infection patterns before day 100 and three patterns after day 100, finding the correlation between both periods.Prolonged mornitoring CMV PP65 antigenemia and DNA can help learning the occurrence and recurrent of CMV in HSCT patients .providing the reference to the clinical treatment of CMV infection. The occurrence of late CMV disease became a major concernin HSCT recipients.