异基因造血干细胞移植后的中枢神经系统感染
Central nervous system infection following allogeneic hematopoietic stem cell transplantation.
作者信息
Hanajiri Ryo, Kobayashi Takeshi, Yoshioka Kosuke, Watanabe Daisuke, Watakabe Kyoko, Murata Yutaka, Hagino Takeshi, Seno Yasushi, Najima Yuho, Igarashi Aiko, Doki Noriko, Kakihana Kazuhiko, Sakamaki Hisashi, Ohashi Kazuteru
机构信息
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
出版信息
Hematol Oncol Stem Cell Ther. 2017 Mar;10(1):22-28. doi: 10.1016/j.hemonc.2016.08.008. Epub 2016 Sep 17.
OBJECTIVE/BACKGROUND: Here, we described the clinical characteristics and outcomes of central nervous system (CNS) infections occurring after allogeneic hematopoietic stem cell transplantation (allo-HSCT) in a single institution over the previous 6 years.
METHODS
Charts of 353 consecutive allogeneic transplant recipients were retrospectively reviewed for CNS infection.
RESULTS
A total of 17 cases of CNS infection were identified at a median of 38 days (range, 10-1028 days) after allo-HSCT. Causative pathogens were human herpesvirus-6 (n=6), enterococcus (n=2), staphylococcus (n=2), streptococcus (n=2), varicella zoster virus (n=1), cytomegalovirus (n=1), John Cunningham virus (n=1), adenovirus (n=1), and Toxoplasma gondii (n=1). The cumulative incidence of CNS infection was 4.1% at 1 year and 5.5% at 5 years.
CONCLUSION
Multivariate analysis revealed that high-risk disease status was a risk factor for developing CNS infection (p=.02), and that overall survival at 3 years after allo-HSCT was 33% in patients with CNS infection and 53% in those without CNS infection (p=.04).
目的/背景：在此，我们描述了过去6年中在单一机构进行异基因造血干细胞移植（allo-HSCT）后发生的中枢神经系统（CNS）感染的临床特征和结局。
方法
对353例连续异基因移植受者的病历进行回顾性分析，以确定是否发生中枢神经系统感染。
结果
在allo-HSCT后中位38天（范围10 - 1028天）共确诊17例中枢神经系统感染。致病病原体包括人类疱疹病毒6型（n = 6）、肠球菌（n = 2）、葡萄球菌（n = 2）、链球菌（n = 2）、水痘带状疱疹病毒（n = 1）、巨细胞病毒（n = 1）、约翰·坎宁安病毒（n = 1）、腺病毒（n = 1）和弓形虫（n = 1）。中枢神经系统感染的累积发病率在1年时为4.1%，5年时为5.5%。
结论
多因素分析显示，高危疾病状态是发生中枢神经系统感染的危险因素（p = 0.02），allo-HSCT后3年时，发生中枢神经系统感染患者的总生存率为33%，未发生中枢神经系统感染患者的总生存率为53%（p = 0.04）。
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