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Prepublished online as a Blood First Edition Paper on February 13, 2003; DOI 10.1182/blood-2002-12-3636. This Article Full Text Full Text (PDF) All Versions of this Article: 2002-12-3636v1 101/12/5053    most recent Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Rights and Permissions Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via Google Scholar Google Scholar Articles by Gerna, G. Articles by Revello, M. G. Search for Related Content PubMed PubMed Citation Articles by Gerna, G. Articles by Revello, M. G. Related Collections Neoplasia Transplantation Clinical Trials and Observations Social Bookmarking                   What's this?  Previous Article  |  Table of Contents  |  Next Article  Blood, 15 June 2003, Vol. 101, No. 12, pp. 5053-5060 TRANSPLANTATION Human cytomegalovirus immediate-early mRNAemia versus pp65 antigenemia for guiding pre-emptive therapy in children and young adults undergoing hematopoietic stem cell transplantation: a prospective, randomized, open-label trial Giuseppe Gerna, Daniele Lilleri, Fausto Baldanti, Maria Torsellini, Giovanna Giorgiani, Marco Zecca, Piero De Stefano, Jaap Middeldorp, Franco Locatelli, and M. Grazia Revello From the Servizio di Virologia, Divisione di Oncoematologia Pediatrica, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Matteo; Istituto di Clinica delle Malattie Infettive, Universitá degli Studi di Pavia, Italy; and the Department of Pathology, Vrije Universiteit Medical Center, Free University of Amsterdam, the Netherlands. In the search for better protocols of preemptive therapy of human cytomegalovirus (HCMV) infection in hematopoietic stem cell transplant (HSCT) recipients, we conducted a randomized trial comparing antigenemia with the nucleic acid sequence–based assay (NASBA) for determination of HCMV immediate-early messenger RNA (IEmRNA) as the guiding assay for initiation of pre-emptive antiviral treatment. In the IEmRNA arm, antiviral therapy was started upon IEmRNA positivity confirmed the following day, whereas in the antigenemia arm, therapy was started in the presence of either at least 2 pp65-positive leukocytes/2 x 105 examined or a single positive leukocyte confirmed the following day. In both arms, treatment was stopped upon 2 consecutive negative results. All patients were monitored for 3 months after HSCT. The primary end point of the study was duration of anti-HCMV therapy. On the whole, 80 children (41 in the IEmRNA and 39 in the antigenemia arm), recipients of transplants from either a relative or an unrelated donor, completed the study. No patient developed HCMV disease. In the IEmRNA arm, the incidence of HCMV infection was higher compared to the antigenemia arm (80% vs 51%, respectively, P = .0069), as well as the percentage of treated patients (66% vs 44%, respectively, P = .045). However, the percentage of relapses and treated relapses was comparable in the 2 arms. There was no significant difference in median duration of therapy per patient. Although these data indicate that IEmRNA determination does not offer advantages in terms of treatment duration, it can safely replace antigenemia, while semiautomation is the major advantage of the NASBA procedure. CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this? This article has been cited by other articles: M. Boeckh and P. Ljungman How we treat cytomegalovirus in hematopoietic cell transplant recipients Blood, June 4, 2009; 113(23): 5711 - 5719. [Abstract] [Full Text] [PDF] D. Lilleri, C. Fornara, A. Chiesa, D. Caldera, E. P. Alessandrino, and G. Gerna Human cytomegalovirus-specific CD4+ and CD8+ T-cell reconstitution in adult allogeneic hematopoietic stem cell transplant recipients and immune control of viral infection Haematologica, February 1, 2008; 93(2): 248 - 256. [Abstract] [Full Text] [PDF] D. Lilleri, G. Gerna, M. Furione, M. E. Bernardo, G. Giorgiani, S. Telli, F. Baldanti, and F. Locatelli Use of a DNAemia cut-off for monitoring human cytomegalovirus infection reduces the number of preemptively treated children and young adults receiving hematopoietic stem-cell transplantation compared with qualitative pp65 antigenemia Blood, October 1, 2007; 110(7): 2757 - 2760. [Abstract] [Full Text] [PDF] D. Lilleri, G. Gerna, C. Fornara, L. Lozza, R. Maccario, and F. Locatelli Prospective simultaneous quantification of human cytomegalovirus-specific CD4+ and CD8+ T-cell reconstitution in young recipients of allogeneic hematopoietic stem cell transplants Blood, August 15, 2006; 108(4): 1406 - 1412. [Abstract] [Full Text] [PDF]

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