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Revisiting cytomegalovirus serology in allogeneic hematopoietic cell transplant recipients

Published inClinical infectious diseases, ciad550
Publication date2023-09-15
First online date2023-09-15
Abstract

Background: Allogeneic hematopoietic cell transplant recipients (allo-HCTR) with positive CMV serology may have false positive results due to blood product transfusions associated passive immunity.

Methods: This is a single-center cohort study including consecutive adult allo-HCTR (01.01.2018-31.12.2022) with negative baseline (at hematologic malignancy diagnosis) and indeterminate or low-positive (CMV-IgG-titer: ≥ 0.6-<50 U/mL) pretransplant CMV-serology with negative pretransplant plasma CMV DNAemia. The CMV serology status of those patients was reclassified from R + to R- (CMVR- reclassification group). We compared those patients to allo-HCTR with negative (CMV-IgG-titer < 0.6 U/mL) pretransplant CMV IgG serology (CMVR- group). We describe the number and type of patients, whose pretransplant CMV serology status was reclassified from indeterminate/positive to negative. Moreover, we reviewed all plasma CMV DNAemia tests performed during the first 6 months posttransplant in both groups, to assess the safety of this approach.

Results: Amongst 246 (84.5%) of 291 transplanted patients identified as CMVR + pretransplant, 60/246 (24.4%) were reclassified from CMV serology indeterminate (N:10) or low-positive (N:50) to R-. Only 1/60 (1.67%) patient in the CMVR- reclassification group vs 3/44(6.8%; p = 0.30) in the CMVR- group developed CMV-DNAemia during the 6-month posttransplant follow-up period. There were no significant differences in the number of CMV-DNAemia tests performed, CMV-DNAemia range and time posttransplant between the two groups.

Conclusion: One out of four allo-HCT CMVR + may be falsely flagged as R+, with significant impact on donor selection and prophylaxis administration. A 2-step approach including CMV-serology testing at hematologic malignancy diagnosis in allo-HCTR candidates and careful review of pretransplant CMV IgG-titers may help correctly classify CMV-serology status.

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Keywords
  • CMV
  • CMV serology
  • Allogeneic hematopoietic cell transplantation
  • False positive
Citation (ISO format)
PORTILLO, Vera et al. Revisiting cytomegalovirus serology in allogeneic hematopoietic cell transplant recipients. In: Clinical infectious diseases, 2023, p. ciad550. doi: 10.1093/cid/ciad550
Main files (2)
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accessLevelRestrictedaccessLevelPublic 09/16/2024
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Identifiers
ISSN of the journal1058-4838
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Technical informations

Creation09/27/2023 9:19:50 AM
First validation01/11/2024 10:50:48 AM
Update time01/11/2024 10:50:48 AM
Status update01/11/2024 10:50:48 AM
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