Chemaly Roy F, Torres Harrys A, Hachem Ray Y, Nogueras Graciela M, Aguilera Elizabeth A, Younes Anas, Luna Mario A, Rodriguez Gilhen, Tarrand Jeffrey J, Raad Issam I
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, 77230, USA.
Cancer. 2005 Sep 15;104(6):1213-20. doi: 10.1002/cncr.21294.
Even when treated with antiviral therapy, cytomegalovirus pneumonia (CMVp) is associated with high morbidity and mortality in immunocompromised patients. CMVp has been rarely reported in patients with lymphoma.
The authors reviewed the records of patients treated at The University of Texas M. D. Anderson Cancer Center (Houston, TX) between 1997 and 2003. Collected information included demographics, use of chemotherapy, or corticosteroids, concomitant infections, and outcome.
Thirty-one patients with lymphoma with 36 episodes of CMVp were identified. The incidence of CMVp increased between 1997 and 2003 (0 of 1000 treated patients vs. 9 of 1000 treated patients; P = 0.07). Most episodes occurred in patients with non-Hodgkin lymphoma (89%). Most of the patients (92%) had received chemotherapy and corticosteroids (89%) before the onset of CMVp. Concomitant CMV antigenemia was detected in 11 (41%) of the 27 episodes in which testing was performed. In 19 episodes (53%), patients had coinfections within 90 days of the episode of CMVp. Coinfections were present at the onset of CMVp in 11 episodes (31%). The yield for CMV in bronchoalveolar lavage (BAL) specimens was higher with culture methods than with cytologic evaluation or immunohistochemical staining (P < 0.001). The number of CMV antigenemia tests performed increased fourfold over the study period. The CMV-attributed mortality rate was 30% (9 of 30 patients). Independent predictors of death by multivariate Cox regression analysis were high APACHE II score (> 16) at onset of CMVp (P = 0.02, hazards ratio [HR] = 15.5, 95% confidence interval [CI], 1.5-163.7), and development of toxicity to antivirals (P = 0.04, HR = 14.03, 95% CI, 1.2-169.1).
The incidence of CMVp in patients with lymphoma is increasing. CMV detection in BAL specimens was better with culture methods than with cytologic or immunohistochemical methods. High APACHE II score and development of antiviral toxicity were associated with a fatal outcome.
即使接受抗病毒治疗，巨细胞病毒肺炎（CMVp）在免疫功能低下患者中仍具有较高的发病率和死亡率。CMVp在淋巴瘤患者中鲜有报道。
作者回顾了1997年至2003年在德克萨斯大学MD安德森癌症中心（休斯顿，德克萨斯州）接受治疗的患者记录。收集的信息包括人口统计学资料、化疗或皮质类固醇的使用情况、合并感染情况及预后。
共识别出31例淋巴瘤患者发生了36次CMVp发作。1997年至2003年间，CMVp的发病率有所上升（每1000例接受治疗的患者中，从0例增至9例；P = 0.07）。大多数发作发生在非霍奇金淋巴瘤患者中（89%）。大多数患者（92%）在CMVp发作前接受过化疗，89%接受过皮质类固醇治疗。在进行检测的27次发作中，11次（41%）检测到合并CMV抗原血症。在19次发作（53%）中，患者在CMVp发作90天内合并其他感染。11次发作（31%）在CMVp发作时即存在合并感染。支气管肺泡灌洗（BAL）标本中，CMV培养法的检出率高于细胞学评估或免疫组化染色法（P < 0.001）。在研究期间，CMV抗原血症检测的次数增加了四倍。CMV所致死亡率为30%（30例患者中有9例）。多因素Cox回归分析显示，CMVp发作时高APACHE II评分（> 16）（P = 0.02，风险比[HR] = 15.5，95%置信区间[CI]，1.5 - 163.7）以及出现抗病毒药物毒性反应（P = 0.04，HR = 14.03，95% CI，1.2 - 169.1）是死亡的独立预测因素。
淋巴瘤患者中CMVp的发病率正在上升。BAL标本中，CMV培养法的检测效果优于细胞学或免疫组化方法。高APACHE II评分和出现抗病毒药物毒性反应与致命结局相关。
