Impact of cytomegalovirus gastrointestinal disease on the clinical outcomes in patients with gastrointestinal graft-versus-host disease in the era of preemptive therapy
Impact of cytomegalovirus gastrointestinal disease on the clinical outcomes in patients with gastrointestinal graft-versus-host disease in the era of preemptive therapy
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DOI：
10.1007/s00277-012-1632-x
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发表时间：
2013-04-01
影响因子：
3.5
通讯作者：
Park, Chong-Won
中科院分区：
文献类型：
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作者：
Cho, Byung-Sik;Yahng, Seung-Ah;Park, Chong-Won
在CMV感染的抢先治疗时代，胃肠道移植物抗宿主病（GI-GVHD）中的巨细胞病毒胃肠道（CMV-GI）疾病尚未得到适当评价。我们调查了103例GI-GVHD患者，他们接受了CMV免疫组化染色的内镜活检。所有受体和/或供体的CMV血清阳性，并监测与先发制人的治疗策略的基础上实时定量聚合酶链反应。26例患者（25%）发生CMV-GI疾病，尤其是在HLA不匹配的移植（P = 0.023）和GVHD初始肠道受累（P = 0.009）中。CMV-GI疾病在随访内窥镜检查（n = 10，39%）和初始内窥镜检查（n = 16，61%）时诊断，随访内窥镜检查占52例接受随访内窥镜检查的患者的19%，初始内窥镜检查占所有GI-GVHD患者的16%。在7例病例中，无论是在初始（n = 5）或随访内窥镜检查（n = 2），CMV-GI疾病的诊断缺乏组织病理学证据的GI-GVHD。值得注意的是，只有11名患者（42%）在诊断CMV-GI疾病之前有既往CMV DNA血症，而12名（46%）和3名（12%）分别有并发和无CMV DNA血症。65%的CMV-GI疾病通过额外的抗病毒治疗得到解决，但CMV-GI疾病（P = 0.032）以及GVHD的严重程度（P = 0.001）对GVHD特异性生存率产生负面影响。总之，我们的数据表明，CMV-GI疾病是相当大比例的GI-GVHD治疗开始后初始或持续GI表现的原因。这表明有必要采取新的策略来减少CMV-GI疾病，并努力通过反复内镜检查来确认CMV。
Cytomegalovirus gastrointestinal (CMV-GI) disease in GI graft-versus-host disease (GI-GVHD) has not been properly evaluated in the era of preemptive therapy for CMV infection. We investigated 103 patients with GI-GVHD who underwent endoscopic biopsies with immunohistochemical staining for CMV. All recipients and/or donors were seropositive for CMV and monitored with a strategy of preemptive therapy based on real-time quantitative polymerase chain reaction. Twenty-six patients (25 %) developed CMV-GI disease, especially in HLA-mismatched transplants (P = 0.023) and with initial gut involvement of GVHD (P = 0.009). The CMV-GI diseases were diagnosed at follow-up endoscopies (n = 10, 39 %), comprising 19 % of 52 patients who underwent follow-up endoscopies, as well as initial endoscopies (n = 16, 61 %), comprising 16 % of all GI-GVHD patients. In seven cases, either at initial (n = 5) or follow-up endoscopies (n = 2), CMV-GI disease was diagnosed in the absence of histopathologic evidence for GI-GVHD. Notably, only 11 patients (42 %) had prior CMV DNAemia before the diagnosis of CMV-GI disease, while 12 (46 %) and three (12 %) had concurrent and no CMV DNAemia, respectively. Sixty-five percent of CMV-GI disease was resolved by additional antiviral therapies, but CMV-GI disease (P = 0.032) as well as severity of GVHD (P = 0.001) negatively affected GVHD-specific survival. In conclusion, our data demonstrate that CMV-GI disease was a cause of initial or persistent GI manifestations after the initiation of therapy in a considerable proportion of GI-GVHD. These suggest the necessity of novel strategies to reduce CMV-GI disease as well as an effort to confirm CMV with repeated endoscopies.