Dziedzic Magdalena, Sadowska-Krawczenko Iwona, Styczynski Jan
Department of Pediatric Hematology and Oncology, Collegium Medicum, Nicolaus Copernicus University Torun, Jurasz University Hospital 1, Bydgoszcz, Poland.
Department of Obstetrics and Gynecology, Collegium Medicum, Nicolaus Copernicus University Torun, Jan Biziel University Hospital 2, Bydgoszcz, Poland.
Anticancer Res. 2017 Dec;37(12):6551-6556. doi: 10.21873/anticanres.12111.
To identify and classify risk factors for cytomegalovirus (CMV) infection and disease in patients receiving allogeneic hematopoietic stem cell transplantation (allo-HSCT), treated mainly for acute leukemia.
A literature search was performed;eligible trials were clinical studies assessing the risk factors for CMV infection or disease in multivariate analysis.
Early reactivation in the setting of allo-HSCT took place mainly in patients without CMV prophylaxis, while late reactivation mainly in those patients who had completed previous prophylaxis or were on anti-CMV strategy based on pre-emptive prophylaxis. We propose classifying risk factors for CMV reactivation and CMV disease in patients after allo-HSCT as major and minor ones. Three major risk factors for CMV reactivation and CMV disease were found: (i) CMV-negative donor CMV-positive recipient serostatus, (ii) acute or chronic graft-versus-host disease, and (iii) unrelated or mismatched donor.
CMV reactivation should be regarded as a continuous function of recipient and donor CMV-seropositivity and recipient immune suppression, caused by conditioning, immunosuppressive therapy and human leukocyte antigen disparity between donor and recipient.
确定并分类接受异基因造血干细胞移植（allo-HSCT）主要治疗急性白血病的患者中巨细胞病毒（CMV）感染和疾病的危险因素。
进行文献检索；符合条件的试验为在多变量分析中评估CMV感染或疾病危险因素的临床研究。
allo-HSCT情况下的早期再激活主要发生在未进行CMV预防的患者中，而晚期再激活主要发生在那些先前已完成预防或基于抢先预防采取抗CMV策略的患者中。我们建议将allo-HSCT后患者CMV再激活和CMV疾病的危险因素分为主要和次要因素。发现了CMV再激活和CMV疾病的三个主要危险因素：（i）CMV阴性供体与CMV阳性受体血清学状态，（ii）急性或慢性移植物抗宿主病，以及（iii）无关或不匹配供体。
CMV再激活应被视为受者和供者CMV血清阳性以及受者免疫抑制的持续作用，这是由预处理、免疫抑制治疗以及供受者之间的人类白细胞抗原差异引起的。
