Solano Carlos, Giménez Estela, Piñana José Luis, Albert Eliseo, Vinuesa Víctor, Hernández-Boluda Juan Carlos, Amat Paula, Navarro David
Hematology Service, Hospital Clínico Universitario, Institute for Research INCLIVA, Valencia, Spain.
Department of Medicine, School of Medicine, University of Valencia, Valencia, Spain.
Transpl Infect Dis. 2017 Aug;19(4). doi: 10.1111/tid.12717. Epub 2017 Jun 20.
We conducted a retrospective single-center study to investigate the potential impact of cytomegalovirus (CMV) DNAemia on mortality in allogeneic stem cell transplant (allo-SCT) recipients.
A total of 151 consecutive patients who underwent T-cell replete allo-SCT were included in the study. Patients with CMV DNAemia were treated preemptively with antivirals upon detection of plasma CMV DNA loads >1500 IU/mL.
At least one episode of CMV DNAemia occurred in 109 (72.2%) patients, and 67 of these patients (61.5%) required one or more courses of antiviral therapy. The cumulative incidence of 1-year overall and non-relapse mortality (NRM) was 28.5% (95% confidence interval [CI], 18.4%-39.5%) and 23.2% (95% CI 12.81%-35.4%), respectively. The occurrence of either CMV DNAemia or CMV recurrences had no apparent effect on 1-year overall mortality and NRM; nevertheless, a trend towards an increased risk of death was seen in patients with one or more episodes of CMV DNAemia requiring antiviral therapy (hazard ratio [HR], 2.10; 95% CI, 0.96-4.61; P=.06 for overall mortality, and HR, 2.36; 95% CI, 0.96-5.76; P=.06 for NRM) but not in those displaying one or more self-resolving episodes.
Therefore, the data suggest that withholding preemptive antiviral therapy until the plasma CMV DNA load reaches 1500 IU/mL has no apparent detrimental effect on patient survival.
我们进行了一项回顾性单中心研究，以调查巨细胞病毒（CMV）血症对异基因干细胞移植（allo-SCT）受者死亡率的潜在影响。
本研究纳入了151例连续接受T细胞充足的allo-SCT的患者。检测到血浆CMV DNA载量>1500 IU/mL时，对CMV血症患者进行抗病毒抢先治疗。
109例（72.2%）患者至少发生过一次CMV血症，其中67例（61.5%）患者需要一个或多个疗程的抗病毒治疗。1年总死亡率和非复发死亡率（NRM）的累积发生率分别为28.5%（95%置信区间[CI]，18.4%-39.5%）和23.2%（95% CI 12.81%-35.4%）。CMV血症或CMV复发的发生对1年总死亡率和NRM没有明显影响；然而，在需要抗病毒治疗的发生一次或多次CMV血症的患者中，观察到死亡风险增加的趋势（总死亡率的风险比[HR]为2.10；95% CI，0.96-4.61；P = 0.06，NRM的HR为2.36；95% CI，0.96-5.76；P = 0.06），但在出现一次或多次自行缓解发作的患者中未观察到这种趋势。
因此，数据表明，在血浆CMV DNA载量达到1500 IU/mL之前不进行抢先抗病毒治疗对患者生存没有明显不利影响。
