Marchesi F, Pimpinelli F, Ensoli F, Mengarelli A
Hematology and Stem Cell Transplant Unit, Regina Elena National Cancer Institute, Rome, Italy.
Molecular Virology, Pathology and Microbiology Laboratory, San Gallicano Dermatological Institute, Rome, Italy.
Hematol Oncol. 2018 Apr;36(2):381-391. doi: 10.1002/hon.2453. Epub 2017 Jun 29.
Cytomegalovirus (CMV) infection in clinical settings other than the allogeneic transplant represents a poorly explored issue. Thus, we performed a comprehensive review of the medical literature about CMV infection in patients undergoing autologous hematopoietic stem cell transplant and in other nontransplant-related hematologic patients. In autologous hematopoietic stem cell transplant, a CMV reactivation is reported to occur in up to 41% of CMV seropositive patients, when a prospective monitoring of antigenemia and/or viremia by polymerase chain reaction was adopted. However, more contained frequencies, up to 12%, have been reported when the monitoring criteria were based on a clinically driven diagnostic strategy. The most relevant risk factors appear to be CD34 + selected autografts, total body irradiation, and prior treatment with Alemtuzumab, Fludarabine, or Bortezomib, respectively. Other possible risk factors (ie, prior treatment with Rituximab, T-cell lymphomas, and pretransplant HBcIgG seropositivity) are still debated. In nontransplant settings, the data are very heterogeneous; thus, CMV infection incidence and risk factors are more difficult to establish. Overall, the rate of CMV infection/reactivation ranges between 2 and 67%. High-dose steroids, advanced disease, poor performance status, and treatment with Alemtuzumab, Fludarabine, Bortezomib, and Rituximab appear as the most relevant, though putative, risk factors. Intravenous Ganciclovir represents the gold standard for first-line treatment of CMV infection in these patients. Oral Valganciclovir and Foscarnet are other possible options. Extensive prophylaxis and preemptive therapy are not generally recommended, with the exception of high-risk patients.
在同种异体移植以外的临床环境中，巨细胞病毒（CMV）感染是一个研究较少的问题。因此，我们对有关接受自体造血干细胞移植的患者以及其他与移植无关的血液病患者中CMV感染的医学文献进行了全面综述。在自体造血干细胞移植中，当采用聚合酶链反应对抗原血症和/或病毒血症进行前瞻性监测时，据报道高达41%的CMV血清阳性患者会出现CMV再激活。然而，当监测标准基于临床驱动的诊断策略时，报告的发生率则较低，高达12%。最相关的危险因素似乎分别是CD34 +选择的自体移植、全身照射以及先前使用阿仑单抗、氟达拉滨或硼替佐米治疗。其他可能的危险因素（即先前使用利妥昔单抗治疗、T细胞淋巴瘤和移植前HBcIgG血清阳性）仍存在争议。在非移植环境中，数据非常不一致；因此，CMV感染的发生率和危险因素更难确定。总体而言，CMV感染/再激活率在2%至67%之间。高剂量类固醇、疾病进展、身体状况差以及使用阿仑单抗、氟达拉滨、硼替佐米和利妥昔单抗治疗似乎是最相关的（尽管是推测性的）危险因素。静脉注射更昔洛韦是这些患者CMV感染一线治疗的金标准。口服缬更昔洛韦和膦甲酸钠是其他可能的选择。除高危患者外，一般不建议进行广泛的预防和抢先治疗。
