Cytomegalovirus infection and disease after allogeneic hematopoietic stem cell transplantation: experience in a center with a high seroprevalence of both CMV and hepatitis B virus
Cytomegalovirus infection and disease after allogeneic hematopoietic stem cell transplantation: experience in a center with a high seroprevalence of both CMV and hepatitis B virus
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DOI：
10.1007/s00277-011-1351-8
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发表时间：
2012-04-01
影响因子：
3.5
通讯作者：
Lin, Sheng-Fung
中科院分区：
文献类型：
--
作者：
Liu, Yi-Chang;Lu, Po-Liang;Lin, Sheng-Fung
巨细胞病毒（CMV）感染和疾病是异基因造血干细胞移植（allo-HSCT）后的重要问题。B型肝炎病毒（HBV）和CMV在慢性病毒持续存在和细胞免疫受损时潜在再活化方面的相似性，引起了临床医生对接受allo-HSCT患者中它们之间的发生和关联的兴趣;然而，仅从CMV和HBV的高血清阳性率区域获得了有限的数据。我们每周通过CMV聚合酶链反应和pp 65抗原血症检测对117名成人allo-HSCT患者进行监测，直至第100天。在我们的病例中，91.8%的供体和受体均为CMV血清阳性，13.7%的患者为HBV表面抗原阳性。CMV感染率为45.3%，CMV病发病率为6.8%。在多变量分析中，II-IV级急性移植物抗宿主病和含抗胸腺细胞球蛋白的预处理方案与CMV感染风险增加相关（风险比3.02，95%CI 1.68-5.42，p < 0.001和风险比5.29，95%CI 2.57-10.8，p < 0.001）。在发生CMV感染（p = 0.699）和CMV疾病（p = 0.093）的患者中未发现生存劣势。未发现有临床意义的HBV再激活，allo-HSCT前供体或受体的潜在HBV感染未增加CMV感染和CMV疾病的风险，也未影响allo-HSCT后的生存率。
Cytomegalovirus (CMV) infection and disease are important concerns after allogeneic hematopoietic stem cell transplantation (allo-HSCT). The similarity of hepatitis B virus (HBV) and CMV with regards to their chronic viral persistence and potential reactivation at the time of impaired cellular immunity has raised clinicians' interest in the occurrence and association between them among patients receiving allo-HSCT; however, only limited data have been obtained from a high seroprevalence region of both CMV and HBV. We monitored 117 adult allo-HSCT patients with both CMV polymerase chain reaction and pp65 antigenemia assay weekly until day 100. In 91.8% of our cases, donors and recipients were both CMV seropositive, and 13.7% of the patients were positive for HBV surface antigen. The incidences of CMV infection and disease were 45.3% and 6.8%, respectively. Grade II-IV acute graft-versus-host disease and anti-thymocyte globulin-containing conditioning regimen were associated with an increased risk of CMV infection in a multivariate analysis (hazard ratio 3.02, 95% CI 1.68-5.42, p < 0.001 and hazard ratio 5.29, 95% CI 2.57-10.8, p < 0.001). No survival disadvantage was found in patients who developed CMV infection (p = 0.699) and CMV disease (p = 0.093). No clinically significant HBV reactivation was found, and the underlying HBV infection in donors or recipients before allo-HSCT did not increase the risk of CMV infection and CMV disease and did not influence survival after allo-HSCT.