Myeloablative Conditioning Predisposes Patients for Toxoplasma gondii Reactivation after Allogeneic Stem Cell Transplantation
Myeloablative Conditioning Predisposes Patients for Toxoplasma gondii Reactivation after Allogeneic Stem Cell Transplantation
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DOI：
10.1086/651266
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发表时间：
2010-04-15
影响因子：
11.8
通讯作者：
Maertens, Johan
中科院分区：
文献类型：
--
作者：
Meers, Stef;Lagrou, Katrien;Maertens, Johan
背景弓形虫病是异基因造血干细胞移植后常见的致命性机会性感染，主要是由于延迟诊断。此外，突破性感染发生在预防与甲氧苄啶磺胺甲恶唑。从2001年11月起，我们对所有弓形虫血清反应阳性和/或从弓形虫血清反应阳性供体接受移植的干细胞移植受者进行常规监测。外周血标本聚合酶链反应检测弓形虫再激活。本研究的目的是评价未接受特异性预防的人群中弓形虫再激活的发生率和危险因素。我们还研究了基于这种常规监测的先发制人治疗方法的可行性。我们报告弓形虫病的发病率为8.7%（18/208例）。12例患者（5.8%）有T。诊断时的弓形虫感染; 6例患者（2.9%）患有弓形虫病，包括脑弓形虫病（n = 5）和心肺弓形虫病（n = 1）。我们确定清髓性预处理和预处理伴随高剂量全身照射（10-12戈伊）是T。弓形虫再激活，而血清反应阳性供体的患者不太可能经历再激活。T.弓形虫病患者血液中的转录本数量显著高于弓形虫病患者。弓形虫感染最后，通过常规监测和克林霉素-乙胺嘧啶的预防性治疗策略，我们的患者中仅发生3例弓形虫相关死亡，远低于文献报道的死亡率。聚合酶链反应系统监测是检测T。弓形虫复活，并能减少T.造血干细胞移植受者中与刚地氏病相关的死亡率
Background. Toxoplasmosis is an often fatal opportunistic infection following allogeneic hematopoietic stem cell transplantation and is largely due to deferred diagnosis. In addition, breakthrough infections occur during prophylaxis with trimethoprim-sulfamethoxazole.Methods. From November 2001 onwards, we routinely monitored all stem cell transplant recipients who were seropositive for Toxoplasma gondii and/or who received a transplant from a donor who was seropositive for T. gondii reactivation by polymerase chain reaction of peripheral blood samples. The aim of this study was to evaluate the incidence of and the risk factors for Toxoplasma reactivation in this population not receiving specific prophylaxis. We also studied the feasibility of a preemptive treatment approach based on this routine monitoring.Results. We report a toxoplasmosis incidence of 8.7% (18 of 208 patients). Twelve patients (5.8%) had a T. gondii infection at diagnosis; 6 patients (2.9%) had Toxoplasma disease, including cerebral toxoplasmosis (n = 5) and cardiopulmonary toxoplasmosis (n = 1). We identified myeloablative conditioning and conditioning with high-dose total body irradiation (10-12 Gy) as risk factors for T. gondii reactivation, whereas patients with a seropositive donor were less likely to experience reactivation. Patients with T. gondii disease had a significantly higher number of transcripts in blood than did patients with a T. gondii infection. Finally, with a strategy of routine monitoring and preemptive treatment with clindamycin-pyrimethamine, we only had 3 Toxoplasma-related deaths among our patients, which is a much lower rate than that reported in the literature.Conclusions. Systematic monitoring with polymerase chain reaction is a good means to detect T. gondii reactivation and could reduce T. gondii-related mortality among hematopoietic stem cell transplant recipients.