Screening for cytomegalovirus (CMV) infection in allogeneic bone marrow transplantation using a quantitative whole blood polymerase chain reaction (PCR) method: analysis of potential risk factors for CMV infection
Screening for cytomegalovirus (CMV) infection in allogeneic bone marrow transplantation using a quantitative whole blood polymerase chain reaction (PCR) method: analysis of potential risk factors for CMV infection
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DOI：
10.1038/sj.bmt.1702778
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发表时间：
2001-02-01
影响因子：
4.8
通讯作者：
Chopra, R
中科院分区：
文献类型：
--
作者：
Qamruddin, AO;Oppenheim, BA;Chopra, R
回顾性回顾了32例2年以上同种异体骨髓移植患者CMV感染的潜在危险因素和CMV定量PCR筛选指导预防性抗CMV治疗的应用。34%的患者出现显著的巨细胞病毒PCR阳性（巨细胞病毒感染的指标）。当通过受体CMV IgG血清状态分析时，69%的血清阳性受体出现显著的CMV PCR阳性，而血清阴性受体没有出现显著的CMV PCR阳性（P = 0.00007）。仅考虑血清阳性受体，100%接受低强度运动- 1h /氟达拉滨/美法兰“迷你异体移植物”调节方案的患者出现显著的CMV PCR阳性，而接受环磷酰胺/TBI的患者中只有44%出现显著的CMV PCR阳性（P = 0.0337）。接受campath/氟达拉滨/美法兰的患者首次出现显著CMV PCR阳性的平均时间为25天，而接受环磷酰胺/TBI的患者为25天。66天（P = 0.0372）。首次出现CMV PCR显著阳性时，campath/氟达拉滨/美法兰组CMV PCR平均指数和峰值分别为4.54和5.22 log copies/ml，环磷酰胺/TBI组CMV PCR平均指数和峰值分别为3.85和4.12 log copies/ml（指数和峰值P = 0.2986和P = 0.0472）。campath/氟达拉滨/美法兰方案CMV PCR显著阳性的患者中有85%出现了不止一次这样的事件，而接受环磷酰胺/TBI方案的患者中有50%出现了这样的事件（P = 0.491）。显著的CMV PCR阳性与一定比例患者的症状相关（发热45%，咳嗽18%，AST升高72%）。没有患者出现明显的巨细胞病毒疾病，巨细胞病毒PCR可用于指导先发制人的抗巨细胞病毒治疗和监测反应。
Potential risk factors for CMV infection and the use of quantitative CMV PCR screening to guide pre-emptive anti-CMV therapy were reviewed retrospectively in 32 allogeneic bone marrow transplant patients accrued over a 2-year period. Significant CMV PCR positivity tan indicator of CMV infection) developed in 34% of patients. When analysed by recipient CMV IgG serostatus, 69% of seropositive recipients developed significant CMV PCR positivity while none of the seronegative recipients did so (P = 0.00007). Considering only the seropositive recipients, 100% of those who received the low intensity campath-1H/fludarabine/melphalan 'mini-allograft' conditioning regimen developed significant CMV PCR positivity, while only 44% of those who had received cyclophosphamide/TBI did so (P = 0.0337), The mean time to first episode of significant CMV PCR positivity for those who had received campath/fludarabine/melphaian was 25 days while for those who had received cyclophosphamide/TBI, this was 66 days (P = 0.0372). For the first episode of significant CMV PCR positivity, the mean index and peak CMV PCR counts for those who had received campath/fludarabine/melphalan were 4.54 and 5.22 log copies/ml respectively, while for cyclophosphamide/TBI, the corresponding figures were 3.85 and 4.12 log copies/ml respectively (P = 0.2986 and P = 0.0472 for index and peak values). 85% of those who had significant CMV PCR positivity with the campath/fludarabine/melphalan regimen developed more than one such episode, while 50% of those receiving cyclophosphamide/TBI regimen did so (P = 0.491). Significant CMV PCR positivity was associated with symptoms in a proportion of patients (pyrexia 45%, cough 18%, rise in AST 72%). No patient developed overt CMV disease, CMV PCR is useful for guiding preemptive anti-CMV therapy and for monitoring response.