Adoptive Immunotherapy for Cytomegalovirus (CMV) Disease in Immunocompromised Patients

Cytomegalovirus (CMV) reactivation in immune compromised patients such as those undergoing hematopoietic progenitor cell transplantation (HPCT) and those with HIV infections can cause severe morbidity and mortality despite treatment with appropriate antiviral agents. The recovery of Cytomegalovirus (CMV) specific cytotoxic T lymphocytes (CTL) plays an important role in the reconstitution of CMV specific immunity in immunocompromised patients. Recent studies have reported that CMV reactivation can be successfully treated by adoptive transfer of CMV-specific T cell clones from CMV seropositive donors expanded in vitro with CMV infected fibroblasts or lysates of CMV infected cells. Other studies have used immune dominant CMV proteins or peptides to expand CMV-specific cytotoxic T lymphocytes. This review describes the clinical manifestations of CMV disease in immunocompromised patients, recent advances of antiviral therapy for CMV disease, the principals of the induction of cellular immune response to CMV, and the clinical application of CMV immunotherapy.

Detection of CMV pp65 antigenemia / 中华传染病杂志

Objective To evaluate the clinical utility of CMV pp65 antigenemia by CMV brite Kit for predicting active/reactive CMV infection S as well as of CMV diseases in bone marrow or peripheral stem cell transplant patients. We also investigated the efficacy of preemptive therapy guided by detection of CMV antigenemia. Methods A total of 210 EDTA anticoagulant plasma samples from 36 bone marrow or Peripheral Stem Cell Transplant Patients were prospectively collected from September 1999 to April 2000. The specific CMV antibody IgG/IgM of all patients were detected by ELISA. We detected CMV pp65 antigenemia by indirect immunofluorescence assay using CMV Brite Kit. All blood samples were detected weekly from week 3 after bone marrow transplantation until 100 days or antigenemia turning negative/dischage or death. Ganciclovir preemptive therapy was initiated at first positive pp65 antigenemia. Results Of 36 bone marrow or Peripheral Stem Cell Transplant Patients, 16 patients occurred positive pp65 antigenemia, 15 patients suffered from symptomatic CMV infections or CMV diseases. In 14 patients of positive pp65 antigenemia receiving gaciclovir therapy at first antigenemia, 2 patients died (mortality rate 14.2%), 12 patients of pp65 antigenemia became negative. Otherwise, 2 untreated cases died. The study showed a significant difference in mortality rate between treated and untreated patients (P