Department of Infectious Diseases, Monash University and Alfred Hospital.
Peter Doherty Institute for Infection and Immunity, University of Melbourne and Royal Melbourne Hospital.
J Infect Dis. 2017 Jun 1;215(11):1684-1694. doi: 10.1093/infdis/jix192.
A simple test to identify recovery of CMV-specific T-cell immunity following hematopoietic stem cell transplantation (HSCT) could assist clinicians in managing CMV-related complications.
In an observational, multicenter, prospective study of 94 HSCT recipients we evaluated CMV-specific T-cell immunity at baseline, 3, 6, 9, and 12 months after transplant using the Quantiferon-CMV, an enzyme-linked immunosorbent spot assay (ELISpot), and intracellular cytokine staining.
At 3 months after HSCT, participants who developed CMV disease (n = 8) compared with CMV reactivation (n = 26) or spontaneous viral control (n = 25) had significantly lower CD8+ T-cell production of interferon-γ (IFN-γ) in response to CMV antigens measured by Quantiferon-CMV (P = .0008). An indeterminate Quantiferon-CMV result had a positive predictive value of 83% and a negative predictive value of 98% for identifying participants at risk of further CMV reactivation. Participants experiencing CMV reactivation compared with patients without CMV reactivation had a reduced proportion of polyfunctional (IFN-γ+/tumor necrosis factor α-positive) CD4+ and CD8+ T cells and a higher proportion of interleukin 2-secreting cells (P = .01 and P = .002, respectively).
Quantifying CMV-specific T-cell immunity after HSCT can identify participants at increased risk of clinically relevant CMV-related outcomes.
一种简单的测试方法可用于识别造血干细胞移植（HSCT）后 CMV 特异性 T 细胞免疫的恢复情况，这将有助于临床医生管理与 CMV 相关的并发症。
在一项针对 94 例 HSCT 受者的观察性、多中心、前瞻性研究中，我们使用 Quantiferon-CMV、酶联免疫斑点分析（ELISpot）和细胞内细胞因子染色法，在移植后 3、6、9 和 12 个月评估 CMV 特异性 T 细胞免疫。
在 HSCT 后 3 个月时，与 CMV 再激活（n = 26）或自发性病毒对照（n = 25）相比，发生 CMV 疾病（n = 8）的参与者对 CMV 抗原的 CD8+T 细胞产生干扰素-γ（IFN-γ）的反应明显降低，这是通过 Quantiferon-CMV 测量的（P =.0008）。不确定的 Quantiferon-CMV 结果对识别有进一步 CMV 再激活风险的参与者具有 83%的阳性预测值和 98%的阴性预测值。与无 CMV 再激活的患者相比，发生 CMV 再激活的患者具有较少的多功能（IFN-γ+/肿瘤坏死因子 α 阳性）CD4+和 CD8+T 细胞，以及较多的白细胞介素 2 分泌细胞（P =.01 和 P =.002）。
HSCT 后量化 CMV 特异性 T 细胞免疫可以识别出具有较高临床相关 CMV 相关结局风险的参与者。
