Department of Haematology, Level II ICPMR, Westmead Hospital, Sydney, New South Wales, Australia.
Bone Marrow Transplant. 2010 May;45(5):849-55. doi: 10.1038/bmt.2009.273. Epub 2009 Nov 16.
Two hundred and ten adult CMV seropositive patients undergoing myeloablative conditioning (MAC) [n=127] or reduced intensity conditioning (RIC) [n=83] transplants (HCT) were serially monitored for CMV reactivation and disease, using a qualitative polymerase chain reaction (PCR) followed by quantitation with pp65 antigen or quantitative PCR. CMV reactivation occurred in 53 RIC (63.9%) and 61 MAC (48%; P=0.03) transplants at a median of 47 days (range: 24-1977). Risk factors identified included acute GVHD (P=0.001), RIC regimen (P=0.03), unrelated donor (P=0.02), use of anti-thymocyte globulin/alemtuzumb (P=0.02) and use of bone marrow in MAC transplants (P=0.011). On multivariate analysis, RIC transplants and acute GVHD remained independent predictors. Treatment with antiviral drugs resulted in CMV negativity rates of 86.8% in MAC and 88.6% in RIC transplants. CMV disease occurred in 10.8% of RIC and 4.7% of MAC transplants (P=0.15). At a median follow-up of 26 months (range: 3-88), 48.1% of RIC and 50.3% of MAC transplants are alive. The higher incidence of CMV reactivation among RIC transplants suggests the need for novel prophylactic or pre-emptive strategies in this high-risk group of patients.
210 例接受清髓性 conditioning (MAC) [n=127] 或减低强度 conditioning (RIC) [n=83] 移植 (HCT) 的成年 CMV 血清阳性患者，采用定性聚合酶链反应 (PCR) 后用 pp65 抗原或定量 PCR 进行定量，连续监测 CMV 再激活和疾病。RIC 移植中有 53 例 (63.9%) 和 MAC 移植中有 61 例 (48%；P=0.03) 在中位数为 47 天 (范围：24-1977) 时发生 CMV 再激活。确定的危险因素包括急性 GVHD (P=0.001)、RIC 方案 (P=0.03)、无关供体 (P=0.02)、使用抗胸腺细胞球蛋白/阿仑单抗 (P=0.02) 和 MAC 移植中使用骨髓 (P=0.011)。多变量分析显示，RIC 移植和急性 GVHD 仍然是独立的预测因素。抗病毒药物治疗使 MAC 和 RIC 移植的 CMV 阴性率分别达到 86.8%和 88.6%。RIC 移植中有 10.8%发生 CMV 疾病，MAC 移植中有 4.7%发生 CMV 疾病 (P=0.15)。中位随访 26 个月 (范围：3-88) 后，RIC 移植中有 48.1%和 MAC 移植中有 50.3%的患者存活。RIC 移植中 CMV 再激活发生率较高，提示在这一高危患者群体中需要新的预防或先发制人的策略。
