Reconstitution of CMV specific immunity in immune-suppressed patients

Doctoral Dissertation uoadl:2838809 191 Read counter

Unit:
Τομέας Υγείας - Μητέρας - Παιδιού
Library of the School of Health Sciences
Deposit date:
2019-01-10
Year:
2018
Author:
Paouri Bilio
Dissertation committee:
Τσολιά Μαρία, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Παπαευαγγέλου Βασιλική, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Καττάμης Αντώνιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μίχος Αθανάσιος, Αναπληρωτής Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Σολδάτου Αλεξάνδρα, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Κοσσυβα Λυδία, Επίκουρη Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Σπυρίδης Νικόλαος, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Original Title:
Η ανοσιακή απάντηση στον CMV σε ανοσοκατασταλμένους ασθενείς
Languages:
Greek
Translated title:
Reconstitution of CMV specific immunity in immune-suppressed patients
Summary:
Allogeneic hematopoietic stem cell transplantation (HSCT) is a life-saving procedure for children suffering from malignant and non malignant diseases. Pediatric hematopoietic stem cell transplant (HSCT) recipients are at high risk for cytomegalovirus (CMV) reactivation due to their immature immune system and therapy following transplantation. Indeed, not only can CMV infection cause severe and multi-organ disease such as retinitis, gastroenteritis, encephalitis, hepatitis, pneumonitis, myocarditis, but it is also associated with the development of bacterial or fungal infections, graft rejection or graft-versus-host-disease (GVHD). Several studies mostly in adult transplant recipients have demonstrated that reconstitution of CMV specific T-cell immunity is associated with control and protection against CMV. Therefore, measuring a patient’s CMI response to CMV may help determine the risk of CMV infection as well as individualize management strategies. At present, several immunological assays are available for monitoring CMV-specific T-cell-mediated immune responses in transplant recipients. However, they are expensive, often require laboratory expertise, and are neither widely available nor standardized.
In this study, the clinical utility of monitoring CMV-specific cell mediated immunity 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 pre-transplant, 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 stable CMV-specific immunity at an average time of 82 days. The cumulative incidence of CMV reactivation in patients who developed CMV-specific immunity was lower than those who did not (15% versus 53%; p=0.023). The receiver operating characteristic (ROC) statistical analysis showed that the area under curve was 0.725 in predicting viremia for QuantiFERON®-CMV test.
In conclusion, in this cohort of HSCT pediatric patients, positive QuantiFERON®-CMV was associated with a low risk of recurrent CMV viremia, accurately reflecting CMV CMI recovery. The QuantiFERON®-CMV assay was a valuable method for identifying pediatric HSCT patients at high risk for CMV viremia. This assay could complement the monitoring and stratification of CMV risk of pediatric patients post-transplantation. Therefore, pediatric patients with positive CMV CMI tests might benefit from less intense surveillance and individualized prophylactic treatment plans.
Main subject category:
Health Sciences
Keywords:
Human cytomegalovirus (h-CMV), Allogeneic hematopoietic stem cell transplantation, Immune response
Index:
No
Number of index pages:
0
Contains images:
Yes
Number of references:
101
Number of pages:
121
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