Paouri Bilio, Soldatou Alexandra, Petrakou Eftihia, Theodosaki Maria, Tsentidis Charalampos, Kaisari Katerina, Oikonomopoulou Christina, Matsas Minos, Goussetis Eugenios
Second Department of Pediatrics, National and Kapodistrian University of Athens, P.& A. Kyriakou Children's Hospital, Athens, Greece.
Stem Cell Transplant Unit, Aghia Sophia Children's Hospital, Athens, Greece.
Pediatr Transplant. 2018 Aug;22(5):e13220. doi: 10.1111/petr.13220. Epub 2018 May 18.
Pediatric HSCT recipients are at high risk for CMV reactivation due to their immature immune system and therapy following transplantation. Reconstitution of CMV-specific T-cell immunity is associated with control and protection against CMV. The clinical utility of monitoring CMV-specific CMI to predict CMV viremia in pediatric HSCT patients using the Quantiferon-CMV (QIAGEN ) test was investigated prospectively. Thirty-seven pediatric allogeneic HSCT recipients were enrolled from 3/2010-6/2012. CMV viremia was detected via weekly real-time PCR. The Quantiferon-CMV test was conducted pretransplant, early after transplantation, 30, 90, 180, 270, and 360 days post-transplantation. The incidence of CMV viremia was 51% (19/37) with half of the episodes within ≤30 days post-transplant. Fifteen patients showed CMV-specific immunity (average of 82 days). The cumulative incidence of CMV reactivation in patients who developed CMV-specific immunity was lower than those who did not (15% vs 53%; P = .023). The ROC statistical analysis showed that the AUC was 0.725 in predicting viremia, for Quantiferon-CMV test. In this cohort, the Quantiferon-CMV assay was a valuable method for identifying pediatric HSCT patients at high risk for CMV viremia, suggesting potential clinical utility to individualize patient's management post-transplant.
由于免疫系统不成熟以及移植后的治疗，小儿造血干细胞移植（HSCT）受者发生巨细胞病毒（CMV）再激活的风险很高。CMV特异性T细胞免疫的重建与对CMV的控制和保护相关。前瞻性研究了使用CMV定量检测（QIAGEN）监测CMV特异性细胞介导免疫（CMI）以预测小儿HSCT患者CMV病毒血症的临床效用。2010年3月至2012年6月招募了37名小儿异基因HSCT受者。通过每周一次的实时PCR检测CMV病毒血症。在移植前、移植后早期、移植后30、90、180、270和360天进行CMV定量检测。CMV病毒血症的发生率为51%（19/37），其中一半的发作发生在移植后≤30天内。15名患者表现出CMV特异性免疫（平均82天）。发生CMV特异性免疫的患者中CMV再激活的累积发生率低于未发生者（15%对53%；P = 0.023）。ROC统计分析显示，CMV定量检测在预测病毒血症方面的曲线下面积（AUC）为0.725。在该队列中，CMV定量检测是识别有CMV病毒血症高风险的小儿HSCT患者的一种有价值的方法，提示其在移植后个体化患者管理方面具有潜在的临床效用。
