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Konrad Schoppel, Christian Schmidt, Hermann Einsele, Holger Hebart, Michael Mach, Reply, The Journal of Infectious Diseases, Volume 180, Issue 5, November 1999, Page 1748, https://doi.org/10.1086/315105
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To the Editor
We appreciate the comments of Volpi et al. [1] about our study [2]. Our results clearly showed an enormous variation in antibody levels against human cytomegalovirus (HCMV) in individual patients after bone marrow transplantation. Eight- to 10-fold changes in titer within a 2-week period were not uncommon, regardless of whether viral replication or HCMV disease was detected. Thus, we feel it is essential to evaluate the kinetics of antibody response in the individual patient. Statistical analyses of a few time points after transplantation or grouping of patients, especially when there are few samples or patients, are not meaningful, since the antibody response after transplantation is so different between patients. Volpi et al. consider a neutralizing antibody response greater than the 90th percentile of asymptomatic patients to be high and postulate a lack of correlation between high neutralizing antibody titers and clinical outcome of the infection.
It would be important to know (1) what posttransplantation time point(s) was used to calculate those titers, (2) the range of neutralizing antibody titers in these patients, and (3) the variation of the assay. Volpi et al. [1] also considered patients showing a 4-fold increase in neutralizing antibody titer to be serologic responders and concluded that serologic response is not important for the clinical outcome of the infection. As mentioned above, we have seen much higher titer fluctuations in individual asymptomatic patients in the absence of any sign of viral replication (determined by polymerase chain reaction and/or antigenemia). Again, it would be important to see the changes in neutralizing titers over time in the individual person.
