Identifying Cytomegalovirus Complications Using the Quantiferon-CMV Assay After Allogeneic Hematopoietic Stem Cell Transplantation

Yong, Michelle K.; Cameron, Paul; Slavin, Monica A; Morrissey, C. Orla; Bergin, Krystal; Spencer, Andrew; Ritchie, David J.; Cheng, Allen; Samri, Assia; Carcelain, Guislaine; Autran, Brigitte; Lewin, Sharon R.

doi:10.1093/infdis/jix192

Cited by 67 publications

(76 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The CMV allograft landscape is changing. Currently two‐thirds of all seropositive HSCT recipients will develop CMV viraemia in the post‐transplant period with the most important risk factor being pre‐transplant recipient and donor CMV serostatus . Pre‐transplant recipient and/or donor CMV seropositivity is also associated with reduced survival and increased transplant‐related mortality compared with CMV seronegative pairs .…”

Section: Epidemiologymentioning

confidence: 99%

“…However, the increasing complexity and use of T‐cell depleting conditioning regimens in HSCT have significantly impacted on the timing and kinetics of CMV viraemia in the post‐transplant period . CMV reactivation is no longer confined to the early post‐HSCT period (<100 days) but may occur months later and with multiple recurrences despite adequate treatment . In addition, the effective use of universal CMV prophylaxis or pre‐emptive therapy in recent years has resulted in a significant decline in CMV tissue invasive end‐organ disease from approximately 30% to 5% .…”

Section: Epidemiologymentioning

confidence: 99%

“…Studies of CMV immune monitoring in the HSCT population have shown clinical benefits in shortening antiviral treatment duration, predicting recurrent CMV reactivation and identifying patients at low risk of CMV complications or with lower CMV viral loads . Identifying patients that have developed reconstitution of CMV‐specific immunity using virological and immunological monitoring post‐HSCT significantly reduced the duration of anti‐CMV pre‐emptive treatment by a median of 9 days .…”

Section: Immune Monitoringmentioning

confidence: 99%

“…Identifying patients that have developed reconstitution of CMV‐specific immunity using virological and immunological monitoring post‐HSCT significantly reduced the duration of anti‐CMV pre‐emptive treatment by a median of 9 days . HSCT recipients with inadequate reconstitution of CMV immunity at day +100 or at the end of first CMV reactivation were much more likely to experience recurrent CMV reactivation, implying that the period for CMV monitoring should be extended. Further research is warranted to determine when to perform immune monitoring and how to assess its clinical impact, including the potential to reduce antiviral use or guide prophylaxis duration.…”

Section: Immune Monitoringmentioning

confidence: 99%

“…Currently twothirds of all seropositive HSCT recipients will develop CMV viraemia in the post-transplant period with the most important risk factor being pre-transplant recipient and donor CMV serostatus. 2 Pre-transplant recipient and/or donor CMV seropositivity is also associated with reduced survival and increased transplant-related mortality compared with CMV seronegative pairs. 3 Other well established and emerging risk factors for CMV include graft versus host disease (GVHD), corticosteroid use, umbilical cord transplants, haploidentical transplants with posttransplant cyclophosphamide and T-cell depleted grafts.…”

Section: Epidemiologymentioning

confidence: 99%

See 4 more Smart Citations

New advances in the management of cytomegalovirus in allogeneic haemopoietic stem cell transplantation

Yong

Gottlieb

Lindsay

et al. 2020

Internal Medicine Journal

Self Cite

View full text Add to dashboard Cite

Cytomegalovirus (CMV) viraemia continues to be a frequent complication in the post‐haemopoietic stem cell transplantation period despite a low incidence of CMV end‐organ disease. Several significant advances in the understanding and management of CMV infection have occurred in the last few years including improved diagnostics, monitoring of CMV immunity, availability of novel anti‐CMV drugs, and emerging use of immunotherapies including CMV‐specific T‐cell infusions. In addition to reviewing these advances we also explore some of the more practical prescribing issues of the older and newer CMV drugs including cost, toxicity and drug interactions to help clinicians navigate this new era of CMV management.

show abstract

Section: Epidemiologymentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

Section: Immune Monitoringmentioning

confidence: 99%

Section: Immune Monitoringmentioning

confidence: 99%

Section: Epidemiologymentioning

confidence: 99%

See 3 more Smart Citations

New advances in the management of cytomegalovirus in allogeneic haemopoietic stem cell transplantation

Yong

Gottlieb

Lindsay

et al. 2020

Internal Medicine Journal

Self Cite

View full text Add to dashboard Cite

show abstract

Advances inCMVinfection prevention and treatment after allo‐HSCT

Girmenia

2019

Adv Cell Gene Ther

View full text Add to dashboard Cite

Cytomegalovirus (CMV) remains a major cause of morbidity and mortality in allogeneic hematopoietic stem cell transplant (HSCT) recipients. Despite this knowledge, a number of CMV-related diagnostic and therapeutic issues remain critical. No uniform guidance exists for the best strategy to monitor and prevent CMV infection and disease. In particular, we lack standard threshold values for assessing the CMV DNAemia in the monitoring of CMV infection; there is no consensus in the adoption of immunoglobulin therapy and adoptive transfer of HSCT donor-derived CMV-specific T cells. Furthermore, antiviral drugs used in the preemptive therapy are characterized by high levels of toxicity. Of interest, recent availability of new drugs will probably modify the antiviral strategy in a large proportion of patients. The uncertainty in the management of CMV infections is further complicated by the continuous evolution in the transplantation strategies and the consequent infectious risk. This paper will focus on challenging issues in the monitoring, prevention, and treatment of CMV infections in allo-HSCT populations. Assessment of pretransplant CMV status, immunological monitoring after transplant, and CMV disease prevention and therapy strategies will be discussed. K E Y W O R D Scytomegalovirus, diagnosis, hematopoietic stem cell transplant, prophylaxis

show abstract

Contemporary analysis of functional immune recovery to opportunistic and vaccine‐preventable infections after allogeneic haemopoietic stem cell transplantation

et al. 2018

Self Cite

View full text Add to dashboard Cite

ObjectivesInfections are a major cause of mortality after allogeneic haemopoietic stem cell transplantation (alloHSCT), and immune recovery is necessary for prevention. Novel transplant procedures have changed the epidemiology of infections but contemporary data on functional immune recovery are limited. In this pilot study, we aimed to measure immune recovery in the current era of alloHSCT.MethodsTwenty, 13, 11, 9 and 9 alloHSCT recipients had blood collected at baseline (time of conditioning) and 3‐, 6‐, 9‐, and 12‐months post‐alloHSCT, respectively. Clinical data were collected, and immune recovery was measured using immunophenotyping, lymphocyte proliferation, cytokine analysis and antibody isotyping.ResultsMedian absolute T‐ and B‐cell counts were below normal from baseline until 9‐ to 12‐months post‐alloHSCT. Median absolute CD4+ T‐cell counts recovered at 12‐months post‐alloHSCT. Positive proliferative responses to Aspergillus, cytomegalovirus (CMV), Epstein‐Barr virus (EBV), influenza and tetanus antigens were detected from 9 months. IL‐6 was the most abundant cytokine in cell cultures. In cultures stimulated with CMV, EBV, influenza and tetanus peptides, the CD4+ T‐cell count correlated with IL‐1β (P = 0.045) and CD8+ T‐cell count with IFNγ (P = 0.013) and IL‐1β (P = 0.012). The NK‐cell count correlated with IL‐1β (P = 0.02) and IL‐17a (P = 0.03). Median serum levels of IgG1, IgG2 and IgG3 were normal while IgG4 and IgA were below normal range throughout follow‐up.ConclusionsThis pilot study demonstrates that immune recovery can be measured using CD4+ T‐cell counts, in vitro antigen stimulation and selected cytokines (IFNγ, IL‐1β, IL‐4, IL‐6, IL‐17, IL‐21, IL‐31) in alloHSCT recipients. While larger studies are required, monitoring immune recovery may have utility in predicting infection risk post‐alloHSCT.

show abstract

Identifying Cytomegalovirus Complications Using the Quantiferon-CMV Assay After Allogeneic Hematopoietic Stem Cell Transplantation

Abstract: Quantifying CMV-specific T-cell immunity after HSCT can identify participants at increased risk of clinically relevant CMV-related outcomes.

Cited by 67 publications

References 38 publications

New advances in the management of cytomegalovirus in allogeneic haemopoietic stem cell transplantation

New advances in the management of cytomegalovirus in allogeneic haemopoietic stem cell transplantation

Advances inCMVinfection prevention and treatment after allo‐HSCT

Contemporary analysis of functional immune recovery to opportunistic and vaccine‐preventable infections after allogeneic haemopoietic stem cell transplantation

Contact Info

Product

Resources

About