Kinetics of inflammatory biomarkers in plasma predict the occurrence and features of cytomegalovirus DNAemia episodes in allogeneic hematopoietic stem cell transplant recipients

Cytomegalovirus (CMV) DNAemia occurs frequently in CMV-seropositive allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients, and usually results from reactivation of latent infection established in the recipient. Predicting the occurrence of CMV DNAemia may be helpful in managing CMV infection in allo-HSCT recipients. Here, the kinetics of several inflammatory biomarkers in plasma were characterized and assessed for their potential value in anticipating the development and features of active CMV infection in allo-HSCT recipients, as documented using real-time PCR assays. The cohort consisted of 46 non-consecutive adult patients who underwent T-cell replete allo-HSCT at our center. Plasma levels of C-reactive protein (CRP), soluble tumor necrosis factor receptor type 2 (sTNF-R2), transforming growth factor-β1 (TGF-β1), and interferon-inducible protein 10 (IP-10/CXCL10) were measured in consecutive specimens obtained from conditioning either by nephelometry (CRP) or by specific immunoassays (the rest). Of the 46 patients, 22 had a first episode of CMV DNAemia at a median of 34 days after allo-HSCT (range, day 19–day 50). We found that both the TGF-β1 area under a curve (AUC) and peak levels were significantly lower in patients who subsequently developed CMV DNAemia than in patients with no CMV DNAemia. Interestingly, CRP but not TGF-β1 AUC and peak levels predicted the occurrence of CMV DNAemia episodes requiring preemptive antiviral therapy. The data presented herein suggest that kinetics of inflammatory biomarkers in plasma might be useful to anticipate post-engraftment CMV DNAemia episodes and predict the need for preemptive antiviral therapy in allo-HSCT recipients.