Transfusion-transmitted cytomegalovirus infection after receipt of leukoreduced blood products
Transfusion-transmitted cytomegalovirus infection after receipt of leukoreduced blood products
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DOI：
10.1182/blood-2002-10-3143
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发表时间：
2003-05-15
期刊：
影响因子：
20.3
通讯作者：
Boeckh, M
中科院分区：
文献类型：
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作者：
Nichols, KG;Price, TH;Boeckh, M
据报道，在预防干细胞（SC）移植后输血传播CMV（TT-CMV）感染方面，去白细胞血液制品与巨细胞病毒（CMV）血清阴性制品相当。为了确定TT-CMV的发病率是否受到白细胞减少血液制品使用增加的影响，我们对807例CMV血清阴性SC移植（SCT）受者进行了前瞻性队列研究，这些受者使用pp 65抗原血症检测进行了全面监测。记录了2个时间段的TT-CMV发生率：第1阶段（5/94-11/96），仅提供CMV血清阴性和/或过滤的血液制品，第2阶段（12/96-2/00），还使用了通过单采术（未过滤）获得的白细胞减少的血小板。第2阶段TT-CMV的发生率（18/447，4%）高于第1阶段（6/360，1.7%）（P <0.05）;这与第2阶段CMV阳性供体的过滤和单采产物利用率较高相关。多变量分析确定CMV阳性供体的过滤红细胞（RBC）单位（但不是单采血小板产品）是TT-CMV的主要预测因子。每增加一个过滤的RBC单位与TT-CMV的几率增加32%相关（95%置信区间[CI]：8%-61%，P = 0.006）。在检测到抗原血症后，用更昔洛韦进行先发制人的治疗，在第100天之前预防了所有CMV疾病，只有一例除外。因此，CMV血清阴性产品在预防TT-CMV方面可能上级于去白细胞产品（特别是过滤的RBC）。在一个普遍减少白细胞的时代，“放弃CMV血清阴性库存似乎为时过早，特别是在没有接受积极监测的CMV疾病高风险人群中。
Leukoreduced blood products are reportedly comparable to cytomegalovirus (CMV)seronegative products for the prevention of transfusion-transmitted CMV (TT-CMV) infection after stem cell (SC) transplantation. To determine if the incidence of TT-CMV was affected by the increasing use of leukoreduced blood Products, we followed a prospective cohort of 807 CMV-seronegative SC transplant (SCT) recipients who underwent weeldy surveillance using the pp65 antigenemia assay. The incidence of TT-CMV for 2 time periods was recorded: period 1 (5/94-11/96), when only CMV-seronegative and/or filtered blood products were provided, and period 2 (12/96-2/00), when leukocyte-reduced platelets obtained by apheresis without filtration were also used. The incidence of TT-CMV was higher during period 2 (18/447, 4%) than period 1 (6/360, 1.7%) (P < .05); this was correlated with higher utilization of both filtered and apheresed products from CMV-positive donors in period 2. Multivarlable analysis identified filtered red blood cell (RBC) units (but not apheresis platelet products) from CMV-positive donors as the primary predictor of TT-CMV. each additional filtered RBC unit was associated with a 32% increase in the odds for TT-CMV (95% confidence interval [CI]: 8%-61%, P = .006). Pre-emptive therapy with ganciclovir after detection of antigenemia prevented all but one case of CMV disease prior to day 100. CMV-seronegative products may thus be superior to leukoreduced products (particularly filtered RBCs) for the prevention of TT-CMV. In an era of 11 universal leukoreduction," the abandonment of CMV-seronegative inventories appears premature, particularly among populations at high risk of CMV disease that do not receive active surveillance.