Tomonari Akira, Takahashi Satoshi, Ooi Jun, Tsukada Nobuhiro, Konuma Takaaki, Kato Seiko, Kasahara Senji, Iseki Tohru, Yamaguchi Takuhiro, Tojo Arinobu, Asano Shigetaka
Department of Hematology/Oncology, The Institute of Medical Science, The University of Tokyo, Tokyo, Japan.
Eur J Haematol. 2008 Mar;80(3):251-7. doi: 10.1111/j.1600-0609.2007.01006.x. Epub 2007 Dec 7.
Cytomegalovirus (CMV) disease is one of the major infectious complications after allogeneic hematopoietic stem cell transplantation (SCT). Several studies have shown that CMV-seropositive patients have a substantial survival disadvantage after bone marrow transplantation (BMT) or peripheral blood SCT (PBSCT). Between August 1998 and February 2006, 101 adult patients underwent myeloablative cord blood transplantation (CBT) from unrelated donors at our institution. Sixteen and 85 patients were CMV-seronegative and CMV-seropositive, respectively, prior to CBT. Outcomes of CBT were compared between CMV-seronegative and CMV-seropositive patients. The cumulative incidences of neutrophil engraftment at 60 d after CBT did not differ between CMV-seronegative and CMV-seropositive patients (100% and 94%, P = 0.09); however, the cumulative incidence of platelet engraftment at 100 d was higher in CMV-seronegative patients than CMV-seropositive patients (100% vs. 86%, P < 0.005). The cumulative incidence of CMV antigenemia at 100 d was lower in CMV-seronegative patients than CMV-seropositive patients (0% vs. 77%, P < 0.001); however, the cumulative incidences of CMV disease did not differ between CMV-seronegative and CMV-seropositive patients (0% vs. 1%, P = 0.84). The probabilities of disease-free survival at 2 yr also did not differ between CMV-seronegative and CMV-seropositive patients (92% vs. 72%, P = 0.16). The outcomes of CBT for CMV-seropositive patients as well as CMV-seronegative patients in our series were favorable. This might be due to effective antiviral therapy for CMV infection. Large-scale studies are needed to determine the impact of recipient CMV serostatus on the outcome of CBT for adults.
巨细胞病毒（CMV）疾病是异基因造血干细胞移植（SCT）后主要的感染性并发症之一。多项研究表明，CMV血清学阳性患者在骨髓移植（BMT）或外周血SCT（PBSCT）后生存劣势明显。1998年8月至2006年2月，我院101例成年患者接受了来自无关供者的清髓性脐血移植（CBT）。CBT前，16例和85例患者分别为CMV血清学阴性和CMV血清学阳性。比较了CMV血清学阴性和CMV血清学阳性患者的CBT结局。CBT后60天中性粒细胞植入的累积发生率在CMV血清学阴性和CMV血清学阳性患者之间无差异（分别为100%和94%，P = 0.09）；然而，CMV血清学阴性患者100天时血小板植入的累积发生率高于CMV血清学阳性患者（100%对86%，P < 0.005）。CMV血清学阴性患者100天时CMV抗原血症的累积发生率低于CMV血清学阳性患者（0%对77%，P < 0.001）；然而，CMV血清学阴性和CMV血清学阳性患者CMV疾病的累积发生率无差异（0%对1%，P = 0.84）。CMV血清学阴性和CMV血清学阳性患者2年无病生存概率也无差异（92%对72%，P = 0.16）。我们系列中CMV血清学阳性患者以及CMV血清学阴性患者的CBT结局良好。这可能归因于针对CMV感染的有效抗病毒治疗。需要开展大规模研究以确定受者CMV血清状态对成人CBT结局的影响。
