The Journal of infectious diseases 2017 04 18() doi 10.1093/infdis/jix192
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.
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).
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).
Quantifying CMV-specific T-cell immunity following HSCT can identify participants at increased risk of clinically relevant CMV-related outcomes.