Torres Harrys A, Kontoyiannis Dimitrios P, Aguilera Elizabeth A, Younes Anas, Luna Mario A, Tarrand Jeffrey J, Nogueras Graciela M, Raad Issam I, Chemaly Roy F
Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030-4009, USA.
Clin Lymphoma Myeloma. 2006 Mar;6(5):393-8. doi: 10.3816/CLM.2006.n.016.
Cytomegalovirus (CMV) antigenemia (CMV-A) and CMV disease (CMV-D), known causes of morbidity and mortality among patients with leukemia and recipients of hematopoietic stem cell transplantations, are described sporadically in patients with lymphoma. We sought to determine the risk factors and outcome of CMV-A and CMV-D among patients with lymphoma.
We conducted a retrospective cohort study with such patients identified between 1997 and 2003 at The University of Texas M. D. Anderson Cancer Center. Seventy-one patients with 82 episodes of CMV-A and/or CMV-D (CMV-A in 38 episodes and CMV-D in 44 episodes) were studied.
Cytomegalovirus antigenemia and/or CMV-D were more common among patients with non-Hodgkin's lymphoma than among those with Hodgkin's disease (P = 0.01). Most CMV infectious episodes occurred in patients who had active (88%) and stage III/IV lymphoma (84%). Eleven of 65 patients (17%) with outcome data died with CMV-A and/or CMV-D. Death with CMV infection was more common among patients with CMV-D than among those with CMV-A (29% vs. 3%, respectively, P = 0.005). Predictors of death by univariate analysis included intensive care unit admission, mechanical ventilation, high antigenemia burden, relapse of CMV-A and/or CMV-D, and antiviral-associated toxicity (all P < 0.05). Multivariate analysis identified antiviral toxicity as the only independent predictor of death (P = 0.01).
In an era of intense and pleiotropic immunosuppressive therapy in patients with lymphoma, CMV-A and CMV-D are significant infections. Preventive strategies might be warranted for patients at risk.
巨细胞病毒（CMV）血症（CMV-A）和CMV疾病（CMV-D）是白血病患者和造血干细胞移植受者发病和死亡的已知原因，在淋巴瘤患者中也有零星报道。我们试图确定淋巴瘤患者中CMV-A和CMV-D的危险因素及预后情况。
我们对1997年至2003年在德克萨斯大学MD安德森癌症中心确诊的此类患者进行了一项回顾性队列研究。研究了71例发生82次CMV-A和/或CMV-D发作的患者（38次为CMV-A发作，44次为CMV-D发作）。
非霍奇金淋巴瘤患者中CMV血症和/或CMV-D比霍奇金病患者更常见（P = 0.01）。大多数CMV感染发作发生在患有活动性淋巴瘤（88%）和III/IV期淋巴瘤（84%）的患者中。65例有预后数据的患者中有11例（17%）死于CMV-A和/或CMV-D。CMV感染导致的死亡在CMV-D患者中比在CMV-A患者中更常见（分别为29%和3%，P = 0.005）。单因素分析显示死亡的预测因素包括入住重症监护病房、机械通气、高抗原血症负荷、CMV-A和/或CMV-D复发以及抗病毒相关毒性（所有P < 0.05）。多因素分析确定抗病毒毒性是死亡的唯一独立预测因素（P = 0.01）。
在淋巴瘤患者接受强化和多效免疫抑制治疗的时代，CMV-A和CMV-D是严重感染。对于有风险的患者可能需要采取预防策略。
