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Blood, 1 November 2000, Vol. 96, No. 9, pp. 3286-3289
BRIEF REPORT
Drug-resistant human cytomegalovirus infection in children after
allogeneic stem cell transplantation may have different clinical
outcomes
Tobias Eckle,
Lothar Prix,
Gerhard Jahn,
Thomas Klingebiel,
Rupert Handgretinger,
Barbara Selle, and
Klaus Hamprecht
From the Department of Medical Virology and
Epidemiology of Viral Diseases, University Hospital Tübingen,
Tübingen, Germany; the Department of Pediatric Oncology and
Hematology, University of Tübingen, Germany; and the Department
of Pediatric Oncology and Hematology, University of Heidelberg,
Germany.
Three seropositive pediatric recipients of allogeneic stem cell
transplantation out of a group of 42 patients receiving
T-cell-depleted, unrelated transplants and 37 patients receiving
T-cell-depleted, haploidentical transplants were monitored
longitudinally for human cytomegalovirus (HCMV) infection and the
emergence of antiviral drug resistance. Early in the
posttransplant course, all 3 patients developed HCMV mutations
conferring drug resistance to ganciclovir. One child additionally
developed multidrug resistance to foscarnet and cidofovir, with
mutations in the viral phosphotransferase gene (UL97) and the
DNA-polymerase gene (UL54) being found. These data show that resistant
HCMV infection does not necessarily correlate with a severe clinical
outcome. The early detection of genotypic resistance up to 129 days
before the emergence of phenotypic resistance and the dissociation of
resistance patterns among different body sites emphasize the importance
of genotypic analyses of different DNA specimens for an
efficient antiviral therapy. T-cell-depleted children having
transplantation might be at an increased risk for the
development of drug resistance.
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