Patients with refractory cytomegalovirus (CMV) infection following allogeneic haematopoietic stem cell transplantation are at high risk for CMV disease and non-relapse mortality
Patients with refractory cytomegalovirus (CMV) infection following allogeneic haematopoietic stem cell transplantation are at high risk for CMV disease and non-relapse mortality
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异基因造血干细胞移植后难治性巨细胞病毒 (CMV) 感染患者发生 CMV 疾病和非复发死亡的风险较高
DOI：
10.1016/j.cmi.2015.06.009
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发表时间：
2015-12-01
影响因子：
14.2
通讯作者：
Huang, X. J.
中科院分区：
文献类型：
--
作者：
Liu, J.;Kong, J.;Huang, X. J.
抢先治疗是控制巨细胞病毒（CMV）的有效方法，然而，难治性CMV仍然发生在相当一组受者异基因造血干细胞移植（allo-HSCT）后。到目前为止，几乎没有任何关于难治性CMV的临床特征和危险因素的数据，或其对allo-HSCT后临床结局的潜在有害影响。我们研究了影响allo-HSCT后100天内难治性CMV的移植因素，以及难治性CMV对CMV疾病风险和非复发死亡率（NRM）的影响。我们回顾性研究了488例allo-HSCT后CMV感染的连续患者。在allo-HSCT后100天内患有难治性CMV的患者的CMV疾病和NRM的发生率高于无难治性CMV的患者（分别为11.9% vs. 0.8%和17.1% vs. 8.3%）。多变量分析显示，allo-HSCT后100天内难治性CMV感染是CMV疾病的独立危险因素（风险比（HR）10.539，95% CI 2.467-45.015，p 0.001），allo-HSCT后60-100天内难治性CMV感染是NRM的独立风险因素（HR 8.435，95% CI 1.511-47.099，p 0.015）。影响难治性CMV感染风险的临床因素包括接受来自人类白细胞抗原不匹配的家庭供体的移植（HR 2.012，95% CI 1.603-2.546，p < 0.001）和急性移植物抗宿主病（HR 1.905，95% CI 1.352-2.686，p < 0.001）。我们的结论是，在allo-HSCT后的早期阶段，难治性CMV感染的患者是CMV疾病和NRM的高风险。临床微生物学和感染（C）2015年欧洲临床微生物学和传染病学会。由爱思唯尔有限公司出版。保留所有权利。
Pre-emptive therapy is an effective approach for cytomegalovirus (CMV) control; however, refractory CMV still occurs in a considerable group of recipients after allogeneic haematopoietic stem cell transplantation (allo-HSCT). Until now, hardly any data have been available about the clinical characteristics and risk factors of refractory CMV, or its potential harmful impact on the clinical outcome following allo-HSCT. We studied transplant factors affecting refractory CMV in the 100 days after allo-HSCT, and the impact of refractory CMV on the risk of CMV disease and non-relapse mortality (NRM). We retrospectively studied 488 consecutive patients with CMV infection after allo-HSCT. Patients with refractory CMV in the 100 days after allo-HSCT had a higher incidence of CMV disease and NRM than those without refractory CMV (11.9% vs. 0.8% and 17.1% vs. 8.3%, respectively). Multivariate analysis showed that refractory CMV infection in the 100 days after allo-HSCT was an independent risk factor for CMV disease (hazard ratio (HR) 10.539, 95% CI 2.467-45.015, p 0.001), and that refractory CMV infection within 60-100 days after allo-HSCT was an independent risk factor for NRM (HR 8.435, 95% CI 1.511-47.099, p 0.015). Clinical factors impacting on the risk of refractory CMV infection included receiving transplants from human leukocyte antigen-mismatched family donors (HR 2.012, 95% CI 1.603-2.546, p < 0.001) and acute graft-versus-host disease (HR 1.905, 95% CI 1.352-2.686, p < 0.001). We conclude that patients with refractory CMV infection during the early stage after allo-HSCT are at high risk for both CMV disease and NRM. Clinical Microbiology and Infection (C) 2015 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved.