Shigematsu Akio, Yasumoto Atsushi, Yamamoto Satoshi, Sugita Junichi, Kondo Takeshi, Onozawa Masahiro, Kahata Kaoru, Endo Tomoyuki, Ota Shuichi, Sato Norihiro, Takahata Mutsumi, Okada Kohei, Tanaka Junji, Hashino Satoshi, Nishio Mitsufumi, Koike Takao, Asaka Masahiro, Imamura Masahiro
Stem Cell Transplantation Center, Hokkaido University Hospital, Sapporo, Japan.
Biol Blood Marrow Transplant. 2009 Jun;15(6):679-85. doi: 10.1016/j.bbmt.2009.02.006. Epub 2009 Apr 11.
Cytomegalovirus (CMV) infection is 1 of the major causes of morbidity in patients undergoing allogeneic stem cell transplantation (allo-SCT). The incidences of CMV antigenemia and CMV disease in 43 patients who received allogeneic bone marrow transplantation (BMT) using a reduced-intensity conditioning (RIC) regimen, which mainly consisted of fludarabine (Flu), busulfan (Bu), and total body irradiation (TBI), were compared with those in 68 patients who received a myeloablative conditioning (MAC) regimen, and risk factors for CMV antigenemia and CMV disease were identified. Before engraftment, grade 3-4 mucosal injury because of the conditioning regimen was significantly decreased in RIC patients (stomatitis: P = .02; diarrhea: P < .01). Rate of engraftment, incidences of acute graft-versus-host disease (aGVHD), and rate of corticosteroid administration were not different in RIC patients and MAC patients. Although the incidences of CMV antigenemia were not significantly different in RIC patients and MAC patients (64.1% versus 57.8%, log rank, P = .59), the incidence of CMV disease was significantly decreased in RIC patients (5.4% versus 20.3%, log rank, P = .04). CMV seropositivity in the patients (P < .01) and corticosteroid administration (P < .01) were revealed by multivariate analysis to be significant risk factors for CMV antigenemia. Grade II-IV aGVHD (P = .02) and grade 3-4 diarrhea before engraftment (P = .04) were revealed to be risk factors for CMV disease. The present study is the first study to show that severe diarrhea before engraftment is a significant risk factor for CMV disease. In summary, risk of CMV disease was significantly decreased in patients without severe mucosal injury of the gut because of the conditioning regimen before engraftment.
巨细胞病毒（CMV）感染是接受异基因干细胞移植（allo-SCT）患者发病的主要原因之一。比较了43例接受以氟达拉滨（Flu）、白消安（Bu）和全身照射（TBI）为主的减低强度预处理（RIC）方案进行异基因骨髓移植（BMT）患者的CMV抗原血症和CMV疾病发生率与68例接受清髓性预处理（MAC）方案患者的发生率，并确定了CMV抗原血症和CMV疾病的危险因素。移植前，RIC患者因预处理方案导致的3-4级黏膜损伤明显减少（口腔炎：P = 0.02；腹泻：P < 0.01）。RIC患者和MAC患者的植入率、急性移植物抗宿主病（aGVHD）发生率和使用皮质类固醇的比例无差异。虽然RIC患者和MAC患者的CMV抗原血症发生率无显著差异（64.1%对57.8%，对数秩检验，P = 0.59），但RIC患者的CMV疾病发生率显著降低（5.4%对20.3%，对数秩检验，P = 0.04）。多因素分析显示患者的CMV血清阳性（P < 0.01）和使用皮质类固醇（P < 0.01）是CMV抗原血症的重要危险因素。II-IV级aGVHD（P = 0.02）和移植前3-4级腹泻（P = 0.04）是CMV疾病的危险因素。本研究是首个表明移植前严重腹泻是CMV疾病重要危险因素的研究。总之，由于移植前预处理方案未导致严重肠道黏膜损伤，患者发生CMV疾病的风险显著降低。
