Clinical features of late cytomegalovirus infection after hematopoietic stem cell transplantation
Clinical features of late cytomegalovirus infection after hematopoietic stem cell transplantation
复制标题
DOI：
10.1007/s12185-008-0051-1
复制
发表时间：
2008-04-01
影响因子：
2.1
通讯作者：
Kurokawa, Mineo
中科院分区：
文献类型：
--
作者：
Asano-Mori, Yuki;Kanda, Yoshinobu;Kurokawa, Mineo
造血干细胞移植（HSCT）后超过100天的晚期巨细胞病毒（CMV）疾病已成为一个日益严重的问题后，引进先发制人更昔洛韦（GCV）管理。为了阐明晚期CMV再激活和疾病的危险因素和结局，我们回顾性分析了1998年至2005年在我院接受同种异体HSCT的101例日本成人患者的记录。51例发生晚期阳性CMV抗原血症，累积发生率为53%。CMV血清阳性、使用阿仑单抗、慢性GVHD和高剂量类固醇与晚期阳性抗原血症显著相关。8例患者发生了晚期CMV疾病，累积发病率为8%，包括视网膜炎和胃肠道疾病。无进展为致死性疾病。Alemtuzumab的使用被确定为晚期CMV疾病的独立显著风险因素，尽管其与非复发死亡率增加无关。在51例晚期阳性抗原血症患者中，28例始终少于3个阳性细胞，其中25例在未使用抗病毒药物的情况下显示阴转。总之，晚期CMV抗原血症似乎经常发生，特别是在严重免疫抑制的患者中;然而，通过最佳的先发制人治疗可以预防致命性结局。低水平抗原血症可能不需要抗病毒治疗。
Late cytomegalovirus (CMV) disease beyond day 100 after hematopoietic stem cell transplantation (HSCT) has become an increasing problem after the introduction of preemptive ganciclovir (GCV) administration. To clarify the risk factors and outcome for late CMV reactivation and disease, we retrospectively analyzed the records of 101 Japanese adult patients who underwent allogeneic HSCT between 1998 and 2005 at our hospital. Fifty-one developed late positive CMV antigenemia, with a cumulative incidence of 53%. Recipient CMV seropositivity, the use of alemtuzumab, chronic GVHD, and high-dose steroids were significantly associated with late positive antigenemia. Eight patients developed late CMV disease, with a cumulative incidence of 8%, including retinitis and gastrointestinal disease. None progressed to a fatal disease. The use of alemtuzumab was identified as an independent significant risk factor for late CMV disease, although it was not associated with increased non-relapse mortality. Among the 51 patients with late positive antigenemia, 28 had consistently less than three positive cells, 25 of whom showed negative conversion without antiviral agents. In conclusion, late CMV antigenemia appeared to develop frequently, especially in patients with profound immune suppression; however, a fatal outcome could be prevented by optimal preemptive therapy. Low-level antigenemia may not require antiviral treatments.