Incidence and outcome of cytomegalovirus infections following nonmyeloablative compared with myeloablative allogeneic stem cell transplantation, a matched control study
Incidence and outcome of cytomegalovirus infections following nonmyeloablative compared with myeloablative allogeneic stem cell transplantation, a matched control study
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DOI：
10.1182/blood.v99.6.1978
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发表时间：
2002-03-15
期刊：
影响因子：
20.3
通讯作者：
Storb, R
中科院分区：
文献类型：
--
作者：
Junghanss, C;Boeckh, M;Storb, R
非清髓性同种异体造血干细胞移植 (HSCT) 越来越多地被探索作为不适合接受传统清髓性 HSCT 的患者的治疗方法。这些移植是否与移植相关感染风险降低有关尚不清楚。我们分析了 56 例连续接受非清髓性 HSCT（TBI，2Gy，第 0 天；移植后 MMF/环孢素）的血液恶性肿瘤患者移植后巨细胞病毒（CMV）感染的发生率。此外，56 名患者中有 18 名在第-4 至-2 天接受了 30 mg/m(2)/d 氟达拉滨。大多数捐赠者是 HLA 匹配且相关的（93%）。每个病例患者与2名在同一时间段（1997年1月至2000年4月）接受传统HSCT治疗的对照者相匹配。匹配标准包括CMV风险组、HSC来源、供者类型、年龄和基础疾病。在前 100 天内，低（供体和受体血清学阴性）和中度（供体血清学阳性和受体阴性）CMV 风险组没有发生 CMV 疾病。在 CMV 高风险病例（血清阳性受者）中，与对照组相比，观察到 CMV 抗原血症 (P = .11)、病毒血症 (P = .16) 和疾病 (P = .08) 较少的趋势；病例中所有严重表现（CMV 病毒血症和疾病）均显着减少 (P = .01)。然而，到第 365 天，两组 CMV 疾病的总体发病率变得相似。与对照组相比，病例患者 CMV 疾病的发病时间显着延迟（中位时间为 130 天 vs 52 天；P = .02）。结论是，非清髓性 HSCT 患者的 CMV 疾病明显延迟，但总体 1 年发病率与清髓性 HSCT 患者相似。因此，非清髓性 HSCT 患者应在 100 天后接受 CMV 监测，并与清髓性 HSCT 患者类似的先发性更昔洛韦治疗。
Nonmyeloablative allogeneic hematopoietic stem cell transplantation (HSCT) is increasingly being explored as therapy in patients who are not eligible for conventional myeloablative HSCT. Whether these transplants are associated with reduced risk of transplantation-related infections is unknown. We analyzed the incidence of posttransplantation cytomegalovirus (CMV) infections in 56 consecutive mycophenolate mofetil (MMF) patients with hematologic malignancies who underwent nonmyeloablative HSCT (TBI, 2Gy, day 0; MMF/cyclosporine after transplantation). In addition, 18 of 56 patients received 30 mg/m(2)/d fludarabine on days -4 to -2. Most donors were HLA matched and related (93%). Each case patient was matched to 2 controls who were treated by conventional HSCT during the same time period (January 1997 through April 2000). Matching criteria included CMV risk group, HSC source, donor type, age, and underlying diseases. No CMV disease occurred in the low (donor and recipient serologically negative) and intermediate (donor serologically positive and recipient negative) CMV risk groups during the first 100 days. Among cases at high risk for CMV (seropositive recipients), trends to less CMV antigenemia (P = .11), viremia (P = .16), and disease (P = .08) compared with controls were observed; all severe manifestations combined (CMV viremia and disease) were significantly reduced among cases (P = .01). However, by day 365, the overall incidence of CMV disease became similar in both groups. The onset of CMV disease was significantly delayed among case patients compared with controls (median, 130 days versus 52 days; P = .02). It was concluded that CMV disease was significantly delayed in nonmyeloablative cases, but that the overall 1-year incidence was similar to myeloablative HSCT patients. Therefore, nonmyeloablative HSCT patients should receive CMV surveillance beyond day 100 and pre-emptive ganciclovir treatment similar to that of myeloablative HSCT patients.