Incidence, risk factors, and outcome of cytomegalovirus viremia and gastroenteritis in patients with gastrointestinal graft-versus-host disease.
Incidence, risk factors, and outcome of cytomegalovirus viremia and gastroenteritis in patients with gastrointestinal graft-versus-host disease.
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DOI：
10.1016/j.bbmt.2014.10.004
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发表时间：
2015-01
影响因子：
4.3
通讯作者：
Uberti, Joseph P.
中科院分区：
文献类型：
--
作者：
Bhutani, Divaya;Dyson, Gregory;Manasa, Richard;Deol, Abhinav;Ratanatharathorn, Voravit;Ayash, Lois;Abidi, Muneer;Lum, Lawrence G.;Al-Kadhimi, Zaid;Uberti, Joseph P.
关键词：
胃肠道(GI)移植物抗宿主病(GVHD)是异基因干细胞移植后发病率和死亡率最常见的原因之一。此外，胃肠道的巨细胞病毒(CMV)感染会使这些患者的移植后病程复杂化，鉴于这两种诊断可能表现出相似的症状，因此很难加以区分。我们回顾分析了252例被诊断为GI GVHD的患者，以评估这些患者中CMV病毒血症和CMV胃肠炎的发生率、危险因素和预后。移植时的中位年龄为51岁，其中35%为亲缘供者移植，65%为非亲缘供者移植。共有114名患者(45%)在移植后出现CMV病毒血症，中位数为34天(14至236天)。只有受体巨细胞病毒免疫球蛋白血清状态与巨细胞病毒血症的发生显著相关(P<；.001)。供受者(D)和受体(R)巨细胞病毒血症的发生率分别为：D+/R+，73%，D−/R+，67%，D+/R−，19%，D−/R−，0。共有31名患者被诊断出患有经活检证实的CMV胃肠炎；2名患者在第一次活检中有CMV胃肠炎和移植物抗宿主病的证据，29例在第二次活检中有证据。移植后发生CMV胃肠炎的中位时间为52天(19至236天)。将死亡作为竞争风险，1年内CMV胃肠炎的累积发病率为16.4%。巨细胞病毒胃肠炎与供受者血清状态的关系如下：D+/R+，22%；D−/R+，31%；D+/R−，12%；D−/R−，0。252例患者的中位总生存期为35.4(23.8~44.8)个月。1年和2年的估计总生存率分别为0.45(95%可信区间[CI]，0.39至0.52)和0.39(95%可信区间，0.33至0.46)。在检查的变量中，与总存活率相关的变量是最大临床移植物抗宿主病分级(P<；.001)和巨细胞病毒胃肠炎的发展(P=.008)。巨细胞病毒血症的发展与死亡率的增加无关。综上所述，巨细胞病毒胃肠炎是胃肠道移植物抗宿主病患者常见的并发症，可对预后产生不利影响。
Gastrointestinal (GI) graft-versus-host disease (GVHD) is 1 of the most common causes of morbidity and mortality after allogeneic stem cell transplantation. In addition, cytomegalovirus (CMV) infection of the gastrointestinal tract can complicate the post-transplantation course of these patients and it can be difficult to differentiate the 2 diagnoses given that they can present with similar symptoms. We retrospectively analyzed 252 patients who were diagnosed with GI GVHD to evaluate the incidence, risk factors, and outcomes of CMV viremia and CMV gastroenteritis in these patients. The median age at the time of transplantation was 51 years, 35% were related donor transplantations, and 65% were unrelated donor transplantations. A total of 114 (45%) patients developed CMV viremia a median of 34 days (range, 14 to 236 days) after transplantation. Only recipient CMV IgG serostatus was significantly associated with development of CMV viremia (P < .001). The incidence of CMV viremia with relation to donor (D) and recipient (R) CMV serostatus subgroups was as follows: D+/R+, 73%; D−/R+, 67%; D+/R−, 19%; and D−/R−, 0. A total of 31 patients were diagnosed with a biopsy-proven CMV gastroenteritis; 2 patients had evidence of CMV gastroenteritis and GVHD on the first biopsy and 29 on the second biopsy. Median time to development of CMV gastroenteritis was 52 days (range, 19 to 236 days) after transplantation. Using death as a competing risk, the cumulative incidence of CMV gastroenteritis at 1 year was 16.4%. The incidence of CMV gastroenteritis in relation to the donor/recipient serostatus was as follows: D+/R+, 22%; D−/R+, 31%; D+/R−, 12%; and D−/R−, 0. Median overall survival of the 252 patients was 35.4 (range, 23.8 to 44.8) months. The estimated overall survival rate at 1 and 2 years was .45 (95% confidence interval [CI], .39 to .52) and .39 (95% CI, .33 to .46), respectively. Of the examined variables, those related to the overall survival were maximal clinical GVHD grade (P < .001) and development of CMV gastroenteritis (P = .008). Development of CMV viremia was not associated with increased mortality. In conclusion, CMV gastroenteritis is common complication in patients with GI GVHD and can adversely affect the prognosis.
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影响因子：
3.5
作者：
Cho, Byung-Sik;Yahng, Seung-Ah;Park, Chong-Won
通讯作者：
Park, Chong-Won
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3.5
作者：
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作者：
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MEYERS, JD
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作者：
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通讯作者：
Chopra, R
影响因子：
20.3
作者：
Hakki, M;Riddell, SR;Boeckh, M
通讯作者：
Boeckh, M