role of clinical, therapeutic and laboratory findings in monitoring of HCMV infection in bone marrow transplant recipients

ABSTRACT

Human cytomegalovirus [HCMV] has been an enormous threat for bone marrow transplant [BMT] recipients. For active and/or latent HCMV infection, diagnosis of the risk factors which increase the risk of posttransplant morbidity and mortality seems necessary. In this research, some of the HCMV risk factors were monitored and compared with HCMV molecular diagnostic methods for better detection of HCMV infection in BMT patients. HCMV risk factors including clinical, biological, biochemical, haematological indexes, and also anti-HCMV and transplant prophylactic and therapeutic conditioning regimens were monitored from March 2002 to March 2006, in 104 BMT patients referred to BMT Unit of Nemazee Hospital in Shiraz University of Medical Sciences and was compared with HCMV molecular methods for BMT donors and recipients' pre- and posttransplantation. Anti-HCMV-lgM was detected in 9.6% and 6.7% of BMT recipients and donors, respectively. Anti-HCMV-lgG was also detected in 8.7% and 9.1% of recipients and donors, pre-transplant, respectively. HCMVPCR results were positive in 20% of recipients and 33.3% of donors. Significant correlations were observed between HCMV positive results and the use of a therapeutic dose, but not the prophylactic dose of glucocorticoids and cyclosporine, pre and post-transplantation. Fasting blood sugar, creatinine, globulin, and liver enzymes levels such as alkaline phosphates and asparagine transpherase significantly correlated with detection of HCMVDNA in transplant patients. Also, negative results of HCMV-PCR significantly correlated with the use of prophylactic dose of acyclovir in BMT patients. Significant correlations of positive and negative HCMV-PCR results with HCMV disease risk factors suggest the possible role of these factors on prognosis and monitoring of HCMV disease in BMT recipients preand post-transplantation