Recent advances in the prevention of CMV infection and disease after hematopoietic stem cell transplantation
Recent advances in the prevention of CMV infection and disease after hematopoietic stem cell transplantation
复制标题
DOI：
10.1111/j.1398-2265.2004.00183.x
复制
发表时间：
2004-06-01
影响因子：
1.3
通讯作者：
Nichols, WG
中科院分区：
文献类型：
--
作者：
Boeckh, M;Fries, B;Nichols, WG
巨细胞病毒(CMV)仍然是造血干细胞移植(HCT)受者的重要病原体，尽管CMV病在移植后3个月内几乎完全消除，但在当前的抗病毒预防和预防性治疗时代，CMV仍然是造血干细胞移植(HCT)患者的重要病原体。移植前供者和/或接受者的CMV血清状况仍然是移植后预后差的重要危险因素，特别是在高度免疫缺陷患者(例如，体外或体外移植的接受者？体内T细胞耗竭)。在选定的高危人群中，预防晚期巨细胞病毒病仍然是一项挑战，巨细胞病毒的间接免疫调节作用(如侵袭性细菌和真菌感染)似乎是造成不良结果的原因之一。在大多数患者中，产生抗病毒耐药性的风险仍然很低；然而，在高度免疫抑制的情况下(例如，从单倍体相合的捐赠者移植后)，发病率可能高达8%。输血传播的巨细胞病毒感染可以通过提供血清阴性或白细胞耗尽的血液产品来减少；然而，1-2%的巨细胞病毒疾病的小风险仍然存在。监测和预防性治疗是预防输血相关巨细胞病毒病的有效方法。开发新的药物和免疫策略(过继转移巨细胞病毒特异性T细胞和供体/受体免疫策略)是消除巨细胞病毒在血细胞移植环境中的负面影响的重要目标。
Cytomegalovirus (CMV) remains an important pathogen in hematopoietic stem cell transplant (HCT) recipients in the current era of antiviral prophylaxis and preemptive therapy, despite the almost complete elimination of CMV disease during the first 3 months after transplantation. Pretransplant CMV serostatus of the donor and/or recipient remains an important risk factor for poor post-transplant outcome, especially in highly immunodeficient patients (e.g. recipients of ex vivo or it? vivo T-cell depletion). Prevention of late CMV disease continues to be a challenge in selected high-risk populations, and indirect immunomodulatory effects of CMV (e.g. invasive bacterial and fungal infections) appear to contribute to the poor outcome. The risk of developing antiviral resistance remains low in most patients; however, in a setting of intense immunosuppression (e.g. after transplantation from a haploidentical donor) the incidence may be as high as 8%. Transfusion-transmitted CMV infection can be reduced by the provision of seronegative or leukocyte-depleted blood products; however, a small risk of 1-2% of CMV disease remains. Surveillance and preemptive therapy is effective in preventing transfusion-related CMV disease. The development of new drugs and immunologic strategies (adoptive transfer of CMV-specific T-cells and donor/recipient vaccination strategies) are important goals for the elimination of the negative impact of CMV in the HCT setting.