Matsumura Tomoko, Narimatsu Hiroto, Kami Masahiro, Yuji Koichiro, Kusumi Eiji, Hori Akiko, Murashige Naoko, Tanaka Yuji, Masuoka Kazuhiro, Wake Atsushi, Miyakoshi Shigesaburo, Kanda Yoshinobu, Taniguchi Shuichi
Department of Hematology, Toranomon Hospital, Tokyo, Japan.
Biol Blood Marrow Transplant. 2007 May;13(5):577-83. doi: 10.1016/j.bbmt.2006.12.454. Epub 2007 Feb 28.
Cytomegalovirus (CMV) infection is a major complication after allogeneic hematopoietic stem cell transplantation (Allo-HSCT); however, we have little information on the clinical features of CMV reactivation after cord blood transplantation using reduced-intensity regimens (RI-CBT) for adults. We reviewed medical records of 140 patients who underwent RI-CBT at Toranomon Hospital between January 2002 and March 2005. All the patients were monitored for CMV-antigenemia weekly, and, if turned positive, received preemptive foscarnet or ganciclovir. Seventy-seven patients developed positive antigenemia at a median onset of day 35 (range, 4-92) after transplant. Median of the maximal number of CMV pp65-positive cells per 50,000 cells was 22 (range, 1-1806). CMV disease developed in 22 patients on a median of day 35 (range, 15-106); 21 had enterocolitis and 1 had adrenalitis. CMV antigenemia had not been detected in 2 patients, when CMV disease was diagnosed. CMV disease was successfully treated using ganciclovir or foscarnet in 14 patients. The other 8 patients died without improvement of CMV disease. In multivariate analysis, grade II-IV acute graft-versus-host disease was a risk factor of CMV disease (relative risk 3.48, 95% confidential interval 1.47-8.23). CMV reactivation and disease develop early after RI-CBT. CMV enterocolitis may be a common complication after RI-CBT.
巨细胞病毒（CMV）感染是异基因造血干细胞移植（Allo-HSCT）后的主要并发症；然而，对于成人采用低强度预处理方案进行脐血移植（RI-CBT）后CMV再激活的临床特征，我们了解甚少。我们回顾了2002年1月至2005年3月在虎之门医院接受RI-CBT的140例患者的病历。所有患者每周监测CMV抗原血症，若呈阳性，则接受抢先使用的膦甲酸钠或更昔洛韦治疗。77例患者在移植后第35天（范围4-92天）中位数时出现抗原血症阳性。每50000个细胞中CMV pp65阳性细胞的最大数量中位数为22（范围1-1806）。22例患者在第35天（范围15-106天）中位数时发生CMV疾病；21例患有小肠结肠炎，1例患有肾上腺炎。在诊断出CMV疾病时，2例患者未检测到CMV抗原血症。14例患者使用更昔洛韦或膦甲酸钠成功治疗了CMV疾病。其他8例患者死于CMV疾病未改善。多因素分析中，II-IV级急性移植物抗宿主病是CMV疾病的危险因素（相对危险度3.48，95%可信区间1.47-8.23）。RI-CBT后CMV再激活和疾病发生较早。CMV小肠结肠炎可能是RI-CBT后的常见并发症。
