Bilgrami S, Aslanzadeh J, Feingold J M, Bona R D, Clive J, Dorsky D, Edwards R L, Tutschka P J
Bone Marrow Transplant Program, University of Connecticut Health Center, Farmington 06030, USA.
Bone Marrow Transplant. 1999 Jul;24(1):69-73. doi: 10.1038/sj.bmt.1701827.
A retrospective evaluation of 200 consecutive recipients of autologous peripheral blood stem cell transplantation (PBSCT) was conducted to ascertain the incidence, risk factors, clinical features, complications, and outcome of cytomegalovirus (CMV) infection. A total of 26 patients (13%) developed CMV viremia (n = 5), DNAemia (n = 3), viruria (n = 18) and/or disease (n = 3) at a median of 45 days following stem cell infusion. None of the patients underwent surveillance testing for CMV. A diagnosis was established by culture and polymerase chain reaction of blood, urine or other tissue samples submitted when patients exhibited clinical features suggestive of CMV infection. Cytomegalovirus seropositivity prior to transplantation was the only statistically significant risk factor predicting subsequent identification of CMV (P < 0.001). The symptoms were severe enough in 23 patients to warrant treatment with intravenous ganciclovir. Three patients developed CMV disease; two developed fatal CMV pneumonia and one developed CMV gastritis which responded to antiviral treatment. Clinical signs and symptoms as well as viremia and viruria resolved with (20 patients) and without (three patients) treatment in the remaining individuals. All instances of CMV viremia, DNAemia, viruria and disease occurred within 3 months of stem cell infusion. These results demonstrate that CMV is a common pathogen after autologous PBSCT and may result in fatality in rare instances. Surveillance programs appear to be neither useful nor cost-effective. Diagnostic evaluation should be performed only in patients exhibiting suspicious clinical features and antiviral chemotherapy should be administered for persistent and severe signs and symptoms.
对200例连续接受自体外周血干细胞移植（PBSCT）的患者进行回顾性评估，以确定巨细胞病毒（CMV）感染的发生率、危险因素、临床特征、并发症及转归。共有26例患者（13%）在干细胞输注后中位45天时发生CMV病毒血症（n = 5）、DNA血症（n = 3）、病毒尿（n = 18）和/或疾病（n = 3）。所有患者均未接受CMV监测检测。当患者出现提示CMV感染的临床特征时，通过对提交的血液、尿液或其他组织样本进行培养和聚合酶链反应来确诊。移植前CMV血清学阳性是预测后续CMV感染的唯一具有统计学意义的危险因素（P < 0.001）。23例患者症状严重，需接受静脉更昔洛韦治疗。3例患者发生CMV疾病；2例发生致命性CMV肺炎，1例发生CMV胃炎，对抗病毒治疗有效。其余患者中，20例患者经治疗、3例患者未经治疗，临床体征和症状以及病毒血症和病毒尿均得到缓解。所有CMV病毒血症、DNA血症、病毒尿和疾病病例均发生在干细胞输注后3个月内。这些结果表明，CMV是自体外周血干细胞移植后常见的病原体，在罕见情况下可能导致死亡。监测方案似乎既无用处也不具有成本效益。仅应对出现可疑临床特征的患者进行诊断评估，对于持续且严重的体征和症状应给予抗病毒化疗。
