Persistent CMV infection after allogeneic hematopoietic stem cell transplantation in a CMV-seronegative donor-to-positive recipient constellation: Development of multidrug resistance in the absence of anti-viral cellular immunity

• Published in: Journal of clinical virology Vol. 74; pp. 57 - 60
• Main Authors: Herling, Marco, Schröder, L, Awerkiew, Sabine, Chakupurakal, Geothy, Holtick, Udo, Kaiser, Rolf, Pfister, Herbert, Scheid, Christof, Di Cristanziano, Veronica
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 01.01.2016
• Subjects: Adult; Allergy and Immunology; Allogeneic hematopoietic stem cell transplantation; Antiviral Agents - therapeutic use; Cytomegalovirus; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - drug therapy; Cytomegalovirus Infections - virology; Drug Resistance, Multiple, Viral; Female; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation - adverse effects; Humans; Immunity, Cellular; Immunocompromised Host; Infectious Disease; Multidrug resistance; QuantiFERON®-CMV assay; Tissue Donors; Transplant Recipients; Transplantation, Homologous - adverse effects; Cytomegalovirus; Allogeneic hematopoietic stem cell transplantation; QuantiFERON ®-CMV assay; Multidrug resistance; QuantiFERON®-CMV assay; QuantiFERON(®)-CMV assay
• ISSN: 1386-6532; 1873-5967
• DOI: 10.1016/j.jcv.2015.11.033

Abstract We describe a case of persistent cytomegalovirus (CMV) infection after allogeneic hematopoietic stem cell transplantation (allo-HSCT) with discordant and high-risk (D−/R+) constellation of CMV serostatus. Despite the use of different and innovative antiviral strategies, viral replication could not be suppressed successfully promoting a protracted CMV colitis associated with severe gastrointestinal graft-versus-host disease (GI GVHD). We illustrate that the development of multidrug viral resistance, the failure to mount a CMV-specific cellular immune response, as confirmed by QuantiFERON® -CMV (Qiagen) assay, and the refractory GVHD requiring prolonged immunosuppression were the main factors contributing to persistent viral replication and the fulminant unfavorable course.