Evaluation of Cytomegalovirus (CMV) T-Cell Mediated Immunity in Children With CMV DNAemia After Allogeneic Hematopoietic Cell Transplantation.
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BACKGROUND: Cytomegalovirus (CMV) is among the most common infectious complications following allogeneic hematopoietic cell transplantation (allo-HCT). The CMV T-cell immunity panel (CMV-TCIP, Viracor) assesses CMV cell-mediated immunity (CMV-CMI); however, its utility among pediatric allo-HCT recipients remains unknown. METHODS: A retrospective analysis (January 2020-January 2024) among pediatric (≤ 18 years) allo-HCT recipients with CMV DNAemia and at least one CMV-TCIP test was performed. A %CMV-CD4+ or %CMV-CD8+ IFN-γ ≤ 0.2% was categorized as a poor response, whereas a result > 0.2% was classified as adequate. Clinically significant CMV infection (csCMVi) was defined as viral load (VL) ≥ 500 IU/mL. CMV-TCIP results were compared to CMV VL and the development of csCMVi after allo-HCT. RESULTS: Twenty-seven CMV-TCIP results from 10 allo-HCT recipients were analyzed. The median age at transplant was 8.5 years (IQR 2.75-14.3), predominantly for hematologic malignancy (70%), and with high-risk CMV serostatus (R+, 90%). At the time of CMV-TCIP testing, subjects with a VL < 500 IU/mL had a higher %CMV-CD4+ IFN-γ compared to those with a VL ≥ 500 IU/mL (0.36 vs. 0.04, p = 0.02). Peak CMV VLs were lower in those with adequate CD4+ and CD8+ T-cell responses than in those with poor CD4+ and CD8+ T-cell responses. In those who received CMV viral-specific T-cells (CMV-VST, n = 5), increased %CD4+ and %CD8+ IFN-γ responses post-infusion were observed with a concordant downward trend in VL. CONCLUSIONS: Our results demonstrate that the development of CMV-CMI (particularly CD4+ IFN-γ > 0.2%) was observed with lower CMV VLs and may provide immunologic insights into pediatric allo-HCT recipients receiving CMV-VST.