SCREENING FOR CMV-SPECIFIC T-CELL PROLIFERATION TO IDENTIFY PATIENTS AT RISK OF DEVELOPING LATE-ONSET CMV DISEASE

Thirty patients undergoing allogeneic BMT were screened post-transplan t together with their marrow donors for CMV-specific T cell proliferat ion and the occurrence of CMV disease, Twenty-one of these patients re ceived a marrow transplant from an HLA-matched sibling donor, and nine from an HLA-matched unrelated donor, All these patients were either C MV seropositive and/or had received a transplant from a CMV-seropositi ve donor, Patients were monitored for CMV-viraemia until day +100 post -SMT by PCR and virus culture, and thereafter by virus culture only wh en clinically indicated. The proliferative T cell response was investi gated at regular monthly intervals beginning on day +30, A proliferati ve response to HCMV (median, day +123) was documented in these patient s between day +37 and +730 post-BMT, None of the patients with a docum ented CMV-specific T cell proliferation on day 120 (n = 17) developed CMV disease in the later posttransplant period, hut of the patients la cking CMV-specific proliferation (n = 13), 30.8% developed CMV disease after day 120, Thus, patients lacking a CMV-specific T-helper cell re sponse might benefit from sensitive screening for CMV infection and pr e-emptive therapy after day +100.