Incidence of refractory cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation
Incidence of refractory cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation
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DOI：
10.1007/s12185-021-03218-3
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发表时间：
2021-10
影响因子：
2.1
通讯作者：
Fumiaki Jinnouchi;Y. Mori;G. Yoshimoto;T. Yamauchi;Takuya Nunomura;Ayano Yurino;Masayasu Hayashi;
中科院分区：
文献类型：
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作者：
Fumiaki Jinnouchi;Y. Mori;G. Yoshimoto;T. Yamauchi;Takuya Nunomura;Ayano Yurino;Masayasu Hayashi;
移植后巨细胞病毒（CMV）疾病几乎可以完全避免目前的感染控制程序。然而，超过一半的患者会发生CMV再激活，一些患者可能会出现临床耐药的CMV感染。耐药性是由于宿主的免疫状态还是病毒耐药性突变引起的，这一点很难确认。因此，在一家机构接受异基因造血干细胞移植的199例连续患者中对难治性CMV感染进行了前瞻性观察分析。其中，143例（72%）患者因CMV再激活而接受抗CMV药物治疗，仅17例（8.5%）表现为难治性CMV感染。这些患者具有临床难治性感染。然而，病毒基因组分析显示，只有一名患者表现出与抗CMV药物耐药性相关的突变。临床耐药主要与宿主免疫因素有关，移植后早期因基因突变引起的耐药发生率较低。
Post-transplant cytomegalovirus (CMV) disease can be almost completely avoided by current infection control procedures. However, CMV reactivation occurs in more than half of patients, and some patients can develop clinically resistant CMV infections. Whether resistance is due to the host’s immune status or a viral resistance mutation is challenging to confirm. Therefore, a prospective observational analysis of refractory CMV infection was conducted in 199 consecutive patients who received allogeneic hematopoietic stem cell transplantation at a single institution. Among them, 143 (72%) patients received anti-CMV drugs due to CMV reactivation, and only 17 (8.5%) exhibited refractory CMV infection. These patients had clinically refractory infection. However, viral genome analysis revealed that only one patient exhibited a mutation associated with the anti-CMV drug resistance. Clinical resistance was mainly correlated with host immune factors, and the incidence of resistance caused by gene mutations was low at the early stage after a transplantation.