CYTOMEGALOVIRUS (CMV) ANTIGENEMIA FOR RAPID DIAGNOSIS AND MONITORING OF CMV-ASSOCIATED DISEASE AFTER BONE-MARROW TRANSPLANTATION

A technique for the rapid detection of cytomegalovirus (CMV) antigen-p ositive blood leucocytes (CMV antigenaemia) was evaluated in 15 marrow transplant patients as a means of diagnosis and for monitoring CMV-as sociated disease. CMV antigenaemia was determined by direct immunopero xidase staining of leucocytes with a peroxidase-labelled monoclonal an tibody, HRP-C7, which binds an immediate-early antigen of human CMV. C MV antigenaemia occurred in 7/15 marrow transplant patients (47%) and was initially detected between 4 and 6 weeks after transplantation. CM V-associated diseases developed in 3/15 patients (20%). All patients w ith CMV-associated disease had a relatively large number of CMV antige n-positive leucocytes, exceeding 10 per 50000 white blood cells (WBCs) . In the remaining 12 patients, CMV antigen-positive leucocytes were l ess than 10 per 50000 WBCs or were undetectable. CMV-associated diseas e did not develop in these patients during the period of monitoring. C MV antigen-positive leucocytes were detected more frequently in patien ts who developed acute graft-versus-host disease (GVHD) or haemorrhagi c cystitis than in those without such complications. CMV antigens were detectable from 1 to 4 weeks before the onset of CMV-associated disea se which allowed initiation of ganciclovir treatment at an early stage . The degree of CMV antigenaemia paralleled the clinical symptoms and signs, higher degrees of antigenaemia being associated with more signi ficant disease. Thus, the detection of CMV antigen-positive blood leuc ocytes is useful for the diagnosis and monitoring of CMV-associated di sease following bone marrow transplantation.