脐血移植后患者 CMV 感染的危险因素：中国多中心研究。
Risk factors of CMV infection in patients after umbilical cord blood transplantation: a multicenter study in China.
机构信息
Shandong University, School of Medicine, Jinan 250012, China; ; Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, China.
Department of Hematology, Anhui Provincial Hospital, Anhui Medical University, Hefei 230001, China.
出版信息
Chin J Cancer Res. 2013 Dec;25(6):695-703. doi: 10.3978/j.issn.1000-9604.2013.11.08.
OBJECTIVE
This retrospective study examined risk factors for cytomegalovirus (CMV) infection after umbilical cord blood transplantation (UCBT) and the impact of CMV infection on patient survival.
METHODS
In all 176 patients, plasma CMV DNA was negative prior to the transplantation, and examined twice a week for 100 d, and then once weekly for additional 300 d. Preemptive antiviral therapy (ganciclovir or foscarnet) was started in patients with >1,000/mL copies of CMV DNA but no full-blown CMV disease, and was discontinued upon two consecutive negative reports of blood CMV DNA test. The survival and risk factors for CMV infection or disease were examined using logistic regression.
RESULTS
CMV infection developed in 71% (125/176) of the patients, with a median onset of 32 d. Four patients (2.3%) developed CMV disease. Neither the 5-year overall survival (OS) nor event-free survival (EFS) differed significantly in infected patients vs. those with no infection (59.4% vs. 64.8%, P=0.194; 53.4% vs. 59.1%, P=0.226). A stepwise multivariate analysis indicated an association of CMV infection with age, high-dose glucocorticoids, the number of transplanted CD34(+) cells, and the number of platelet transfusion, but not with gender, the conditioning regimen, and the day of neutrophil recovery and chronic graft-versus-host disease (cGVHD).
CONCLUSIONS
CMV infection is very common after UCBT, but does not seem to affect long-term survival with preemptive antiviral treatment.
目的
本回顾性研究探讨了脐血移植（UCBT）后巨细胞病毒（CMV）感染的危险因素，以及 CMV 感染对患者生存的影响。
方法
在所有 176 例患者中，移植前血浆 CMV DNA 均为阴性，在 100 天内每周检测两次，之后再检测 300 天，每周一次。对于 CMV DNA 拷贝数＞1000/mL 但尚未出现完全 CMV 疾病的患者，给予预防性抗病毒治疗（更昔洛韦或膦甲酸钠），当连续两次血液 CMV DNA 检测均为阴性时停药。采用逻辑回归分析 CMV 感染或疾病的生存和危险因素。
结果
71%（125/176）的患者发生了 CMV 感染，中位发病时间为 32 天。4 例（2.3%）患者发生 CMV 疾病。与未感染患者相比，感染患者的 5 年总生存（OS）和无事件生存（EFS）无显著差异（59.4% vs. 64.8%，P=0.194；53.4% vs. 59.1%，P=0.226）。逐步多因素分析表明，CMV 感染与年龄、大剂量糖皮质激素、移植的 CD34+细胞数和血小板输注数相关，与性别、预处理方案以及中性粒细胞恢复和慢性移植物抗宿主病（cGVHD）的天数无关。
结论
UCBT 后 CMV 感染非常常见，但在进行预防性抗病毒治疗后，似乎不会影响长期生存。
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