Use of PCR serum in diagnosing and monitoring cytomegalovirus reactivationin bone marrow transplant recipients

We previously reported that the use of polymerase chain reaction (PCR) in d etecting cytomegalovirus (CMV) DNA in serum (sPCR) enables the detection of CMV viremia, which has not been possible with other methods. In this study , the clinical usefulness of sPCR was investigated by comparison with the r esults of three other diagnostic methods, i.e., antigenemia assay (AG), she ll vial culture test (shell vial), and complement-fixing (CF) antibody tite r. The present study included 26 patients with hematological diseases who h ad undergone allogeneic bone marrow transplantation (BMT). A total of 347 s amples were collected, and the results of the sPCR and AG methods were in a greement in 91.1% of the samples. When a subject was positive in both the s PCR and AG tests, and the other two tests (shell vial and CF) were also pos itive, CMV reactivation was surmised as definite. When only the result of t he shell vial test or the CF test was positive, these results were taken as false-positives. The time at which the samples became positive in each of these four tests was 7.5 weeks post-BMT for sPCR, 7.0 weeks post-BMT for th e AG test, 7.4 weeks post-BMT for the shell vial test, and 9.7 weeks post-B MT for the CF test. Thus, it was found that samples became positive at almo st the same time for the sPCR, AG, and shell vial tests. Interstitial pneum onitis (IP) due to CMV developed in 3 subjects. These cases were positive i n the sPCR, AG, and shell vial tests prior to the manifestation of symptoms of IF. The CF test did not become positive until after the onset of the di sease. As the IP due to CMV was controlled with treatment, the sPCR and AG tests became negative. With the shell vial and CF tests, on the other hand, the test results continued to be positive even after the IP was cured. The se findings demonstrate that the sPCR test method-like the AG test-yields f ew false-positive results. Therefore, the sPCR method is useful in early di agnosis of reactivation of CMV and for evaluation of the efficacy of therap y administered for IF. In addition, sPCR can be performed simultaneously on a large number of samples, and the evaluation of the test results is simpl e. We conclude that the sPCR test may be superior to the three other diagno stic methods for evaluation of serum samples from multiple institutions. (C ) 1999 The Japanese Society of Hematology.