Cytomegalovirus load at treatment initiation is predictive of time to resolution of viremia and duration of therapy in hematopoietic cell transplant recipients |
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| Affiliation: | 1. Department of Medicine, Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CA, USA;2. Department of Pathology, Stanford University School of Medicine, Stanford, CA, USA;1. Department of Hematology, Oncology, Hemostaseology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany;2. CHU de Lille, LIRIC, INSERM U995, University of Lille 2, France;3. Project Management, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany;4. Medfacilities, GmbH, Cologne, Germany;5. Department of Infection Control and Infectious Diseases, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany;6. Division of Pediatric Hematology, Oncology and Stem Cell Transplantation, University Hospital RWTH Aachen, Medical Faculty, Aachen, Germany;1. Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA;2. Division of Allergy and Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA;3. Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA;4. Institute of Medical Microbiology and Hygiene, University of Regensburg, Regensburg, Germany;5. Institute of Clinical Microbiology and Hygiene, University Hospital Regensburg, Regensburg, Germany;6. Division of Medical Oncology, Department of Medicine;7. Department of Laboratory Medicine and Pathology, University of Washington, Seattle, WA;1. Facultad de ciencias de la salud, Universidad Icesi, Cali, Colombia;2. Fundación Valle del Lili, Cali, Colombia;1. Transplantation Center, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China;2. Wenzhou Key Laboratory of Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, China |
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| Abstract: | BackgroundPreemptive antiviral therapy relies on viral load measurements and is the mainstay of cytomegalovirus (CMV) prevention in hematopoietic cell transplant (HCT) recipients. However, optimal CMV levels for the initiation of preemptive therapy have not been defined.ObjectivesThe objectives of our work were to evaluate the relationship between plasma CMV DNA levels at initiation of preemptive therapy with time to resolution of viremia and duration of treatment.Study designRetrospective analysis of HCT recipients undergoing serial CMV PCR testing between June 2011 and June 2014 was performed.Results221 HCT recipients underwent preemptive therapy for 305 episodes of CMV viremia. Median time to resolution was shorter when treatment was initiated at lower CMV levels (15 days at 135–440 international units (IU)/mL, 18 days at 441–1000 IU/mL, and 21 days at >1000 IU/mL, P < .001). Prolonged viremia lasting >30 days occurred less frequently when treatment was initiated at 135–440 IU/mL compared to 441–1000 IU/mL and >1000 IU/mL (1%, 15%, 24%, P < .001). Median treatment duration was also shorter in the lower viral load groups (28, 34, 37 days, P < .001).ConclusionInitiation of preemptive therapy at low CMV levels was associated with shorter episodes of viremia and courses of antiviral therapy. These data support the utility of initiating preemptive CMV therapy at viral loads as low as 135 IU/mL in HCT recipients. |
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| Keywords: | Cytomegalovirus Quantitative real-time polymerase chain reaction WHO International Standard Hematopoietic cell transplantation Pre-emptive therapy Viral load |
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