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Identifying Cytomegalovirus (CMV) complications using the Quantiferon-CMV assay after Allogeneic Hematopoietic Stem Cell Transplantation.

Identifying Cytomegalovirus (CMV) complications using the Quantiferon-CMV assay after Allogeneic Hematopoietic Stem Cell Transplantation.
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Yong MK, Cameron PU, Slavin M, Morrissey CO, Bergin K, Spencer A, Ritchie D, Cheng AC, Samri A, Carcelain G, Autran B, Lewin SR,


Yong MK, Cameron PU, Slavin M, Morrissey CO, Bergin K, Spencer A, Ritchie D, Cheng AC, Samri A, Carcelain G, Autran B, Lewin SR, (click to view)

Yong MK, Cameron PU, Slavin M, Morrissey CO, Bergin K, Spencer A, Ritchie D, Cheng AC, Samri A, Carcelain G, Autran B, Lewin SR,

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The Journal of infectious diseases 2017 04 18() doi 10.1093/infdis/jix192

Abstract
Background
Cytomegalovirus (CMV) reactivation and disease remain a major cause of morbidity and mortality in hematopoietic stem cell transplant (HSCT) recipients. A simple test to identify recovery of CMV-specific T-cell immunity could assist clinicians in managing CMV-related complications.

Methods
In an observational multi-centre prospective study of 94 allogeneic HSCT recipients we evaluated CMV-specific T-cell immunity at baseline, 3, 6, 9 and 12 months post-transplant using the Quantiferon-CMV®, an ELISpot assay and in a subset, we also evaluated intracellular cytokine staining (ICS).

Results
At 3 months post HSCT, participants who developed CMV disease (n=8) compared to those with CMV reactivation (n=26) or spontaneous viral control (n=25) had significantly lower CD8+ T-cell production of IFN-γ in response to CMV antigens measured by Quantiferon-CMV (p=0.0008). 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 to without CMV reactivation had a reduced proportion of polyfunctional (IFN-γ+/TNF+) CD4+ and CD8+ T-cells, and a higher proportion of IL-2 secreting cells (p=0.014 and p=0.002 respectively).

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

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