Cytomegalovirus (CMV) DNAemia occurs frequently in allogeneic hematopoietic stem cell transplant recipients (allo-HSCT). There is limited information about the incidence, features, and clinical impact of CMV DNAemia blips (episodes defined by an isolated positive PCR result) in this setting. In this retrospective study, 225 consecutive adult patients undergoing any modality of allo-HSCT at our center between May 2012 and July 2019 were included. Plasma CMV DNA load was monitored using a highly sensitive real-time PCR assay. In all, 187 of 225 patients had CMV DNAemia through day 365 after allo-HSCT (total number of episodes, n = 379). Eighty-three of the 187 patients had 1 or more blips (n = 104). Blips occurred as a first episode of CMV DNAemia as opposed to prolonged CMV DNAemia (≥2 consecutive positive PCR results) in 47 patients; in 20 of these patients, blips represented the only documented episode throughout the study period, and in 27 patients, blips preceded a prolonged CMV DNAemia episode. In the remaining 36 patients, blips developed as recurrences. Blips presenting as initial episodes occurred more frequently (P < .001) in patients receiving an allograft from a CMV-seropositive donor. The cumulative incidence of recurrent CMV DNAemia following initial blips, self-resolving prolonged CMV DNAemia episodes, or CMV DNAemia episodes treated preemptively with antivirals was not significantly different (P = .34). Receiver operating characteristic curve analysis indicated that a CMV DNA load cutoff of 48 IU/mL yielded the highest combined sensitivity (66%) and specificity (70.2%) for predicting a prolonged CMV DNAemia episode. The practical implications of our data in the optimization of preemptive antiviral therapy strategies are discussed.

中文翻译：

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异体造血干细胞移植受者中巨细胞病毒DNAemia斑点的特征：对先发抗病毒治疗策略优化的意义。

巨细胞病毒（CMV）DNAemia经常发生在同种异体造血干细胞移植受体（allo-HSCT）中。在这种情况下，有关CMV DNAemia斑点（由孤立的阳性PCR结果定义的片段）的发生率，特征和临床影响的信息有限。在这项回顾性研究中，纳入了2012年5月至2019年7月期间在我们中心接受过allo-HSCT方式治疗的225名连续成年患者。使用高度灵敏的实时PCR分析法监测血浆CMV DNA负载。总共225名患者中的187名在异基因造血干细胞移植后的第365天有CMV DNA血症（总发作次数，n = 379）。187例患者中有83例出现1次或更多次斑点（n = 104）。在47例患者中，与CMV DNAemia延长（≥2个连续的阳性PCR结果）相比，CMV DNAemia的首次发作是发lip。在这些患者中，有20例是整个研究期间唯一记录的发作，而在27例患者中，在CMV DNAemia发作延长之前出现了发作。在其余的36名患者中，复发出现斑点。在从CMV血清反应阳性供体接受同种异体移植的患者中，以初期发作为特征的斑点发生率更高（P <.001）。初次出现斑点，自我解决延长的CMV DNAemia发作或先用抗病毒药治疗后的CMV DNAemia发作后，复发性CMV DNAemia的累积发生率无显着差异（P = 0.34）。接收器工作特征曲线分析表明，CMV DNA负荷临界值48 IU / mL产生了最高的联合敏感性（66％）和特异性（70.2％），可预测长时间的CMV DNAemia发作。