Surveillance of cytomegalovirus infection in haematopoietic stem cell transplantation patients Sandra H.A. Bonon a , Silvia M.F. Menoni a , Cla ´udio L. Rossi b , Ca ´rmino A. De Souza c , Afonso C. Vigorito c , Daniel B. Costa d , Sandra C.B. Costa a, * a Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas (UNICAMP), CP 6111, CEP 13081-970,Campinas, Sa˜o Paulo, Brazil b Department of Clinical Pathology, Faculty of Medical Sciences, State University of Campinas (UNICAMP), CP 6111, CEP 13081-970,Campinas, Sa˜o Paulo, Brazil c Bone Marrow Transplant Unit, Hemocenter, Faculty of Medical Sciences, State University of Campinas (UNICAMP), CP 6111, CEP 13081-970, Campinas, Sa ˜o Paulo, Brazil d Department of Internal Medicine, Yale University School of Medicine, New Haven, CT, USA Accepted 29 November 2003 Available online 24 December 2003 KEYWORDS Cytomegalovirus infection; PCR; Bone marrow transplantation Summary Objectives. The aim of this study was to describe our experience in the control of active CMV infection following HSCT using two strategies of CMV infection treatment: ganciclovir universal prophylaxis at low doses and pre-emptive therapy with ganciclovir. Methods. The surveillance was based on the monitoring of antigenaemia (AGM) and on a nested polymerase chain reaction (N-PCR) for the detection of CMV in both strategies. Forty-five recipients with malignant diseases and with a risk for CMV disease received universal prophylaxis (Group A). The non-treated group consisted of 24 patients, most of them with non-malignant diseases who did not receive universal prophylaxis (Group B). Results. In Group A, the incidence of positive AGM was 51%, with a positive PCR of 68.9%. In Group B, the AGM positivity was 66.7% and that of N-PCR was 66.7%. CMV disease occurred in 6/55 patients (10.9%), with 2/36 (5.5%) from Group A and 4/19 (21%) from Group B. Two of these six patients (33.3%) died of CMV disease. Conclusions. Our result suggests that AGM and N-PCR can be used as markers for assessing the monitoring and the introduction pre-emptive therapy. This approach could prove to be more cost-effective than ganciclovir universal prophylaxis for treating CMV infection. Q 2003 The British Infection Society. Published by Elsevier Ltd. All rights reserved. Introduction Cytomegalovirus (CMV) infection after haemato- poietic stem cell transplantation (HSCT) produces significant morbidity and mortality. 1,2 Ganciclovir (GCV) has been established as an effective Journal of Infection (2005) 50, 130–137 www.elsevierhealth.com/journals/jinf 0163-4453/$30.00 Q 2003 The British Infection Society. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.jinf.2003.11.010 *Corresponding author. Tel.: þ55-019-3788-7734; fax: þ 55- 019-3289-4107. E-mail address: costa@fcm.unicamp.br