Detección precoz de infección por citomegalovirus en pacientes sometidos a trasplante alogéneico de precursores hematopoyéticos por reacción de polimerasa en cadena cuantitativa en tiempo real

Abstract

Introduction: CMV pp65-antigenemia (antigenemia) has been used for monitoring CMV viremia in allogeneic hematopoietic stem cell transplant (aHSCT) recipients. Recently, real time quantitative PCR (RT-qPCR) has been used as a better approach than antigenemia for CMV diagnosis. The objective of this study was to assess the correlation of CMV viremia between RT-qPCR and antigenemia in aHSCT patients. Material and Methods: Observational prospective study of all aHSCT patients during 10 months in our center. CMV RT-qPCR in whole blood was performed weekly from day +7 to +100 after aHSCT. Simultaneous antigenemia was performed from engrafment to day +100. Concordance between both assays was evaluated. Results: Eighteen patients were included. In 120 simultaneous samples, 96 were concordant by both methods (80%). Kappa coefficient was 0.583. In 42% of cases without concordant results, patients were on antiviral therapy. Thirteen patients (72%) developed CMV infection (20 episodes). In 17 episodes, both the antigenemia and CMV RT-qPCR were positive. CMV RT-qPCR was detectable 1-2 weeks before antigenemia in 45% of the episodes. Conclusion: Both methods had a moderate concordance and CMV RT-qPCR detects CMV reactivations earlier than antigenemia, especially in neutropenic patients.