DEMONSTRATION OF CYTOMEGALOVIRUS AFTER BONE-MARROW TRANSPLANTATION BYPOLYMERASE CHAIN-REACTION, VIRUS CULTURE AND ANTIGEN-DETECTION IN BUFFY COAT LEUKOCYTES

We prospectively monitored buffy coat leukocytes of 47 patients after 50 marrow transplantations tautologous n = 18, allogeneic n = 32) by p olymerase chain reaction (PCR) for the presence of cytomegalovirus (CM V). None of the 18 autologous graft recipients (9 seropositive, 9 sero negative) had positive PCR results or CMV disease throughout the post- transplantation course. Six of 32 allograft recipients (19 seropositiv e, 13 seronegative) became PCR positive, four of whom developed CMV di sease. PCR positive patients mere found more often (5 of 10) in the gr oup with acute GVHD grade II-IV compared with 1 of 22 in the group wit hout or with grade I acute GVHD (p = 0.002). Comparison of PCR with an tigen assay and virus culture showed an agreement in 90 of 96 (94%) sa mples. Discordant results were due to a higher sensitivity of the PCR compared with antigen assay (n = 1) and virus culture (n = 6). In conc lusion, PCR helps to identify those patients who will not develop CMV disease and narrows down the number of patients who eventually mill su fer symptomatic CR 1[V infection. Furthermore, PCR is a useful tool fo r following the post-transplantation course with respect to CMV and fo r judging the effect of antiviral treatment.