CD34 选择的造血细胞移植受者中的巨细胞病毒耐药性。
Cytomegalovirus resistance in CD34 -selected hematopoietic cell transplant recipients.
作者信息
Kim Seong Jin, Huang Yao-Ting, Foldi Julia, Lee Yeon Joo, Maloy Molly, Giralt Sergio A, Jakubowski Ann A, Papanicolaou Genovefa A
机构信息
Infectious Disease Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Weill Medical College, Cornell University, New York, NY, USA.
出版信息
Transpl Infect Dis. 2018 Jun;20(3):e12881. doi: 10.1111/tid.12881. Epub 2018 Apr 10.
BACKGROUND
Cytomegalovirus (CMV) viremia after CD34 -selected hematopoietic stem cell transplant (HCT) often requires prolonged antiviral therapy. We report rates and outcomes of resistant CMV in a contemporary cohort of CD34 -selected HCT recipients managed preemptively.
METHODS
We retrospectively reviewed 220 consecutive, CMV-seropositive recipients (R+), who received CD34 -selected HCT at Memorial Sloan Kettering Cancer Center between June 2010 and December 2014. Patients were monitored by quantitative CMV PCR and were treated preemptively. CMV resistance was tested by a genotypic assay.
RESULTS
One hundred and sixty-one (73%) patients developed CMV viremia and 47 (29% of viremic and 21% of total patients) had CMV resistance testing by one-year from HCT. CMV resistance was confirmed in 19 (12% of viremic and 9% of total) patients and was identified >3 months from HCT in 90% of patients. Twelve patients had mutations in UL97 only; the remaining 7 patients had mutations in UL54 only or UL54 and UL97. By 1 year from HCT, 11 of 19 (58%) patients with mutations had CMV end-organ disease. CMV-related mortality in patients with resistance was 42%.
CONCLUSIONS
Nine percent of CMV R+, CD34 -selected HCT recipients had resistant CMV by 1 year from HCT. Of 19 patients with resistant CMV, 58% had CMV end-organ disease and 42% died of CMV. Effective strategies for CMV prevention and restoration of CMV immunity are needed for CD34 -selected HCT.
背景
CD34 选择的造血干细胞移植（HCT）后巨细胞病毒（CMV）血症通常需要延长抗病毒治疗。我们报告了在当代一组接受抢先治疗的 CD34 选择的 HCT 受者中 CMV 耐药的发生率和结局。
方法
我们回顾性分析了 2010 年 6 月至 2014 年 12 月在纪念斯隆凯特琳癌症中心接受 CD34 选择的 HCT 的 220 例连续的 CMV 血清学阳性受者（R+）。通过定量 CMV PCR 对患者进行监测并进行抢先治疗。通过基因分型检测 CMV 耐药性。
结果
161 例（73%）患者发生 CMV 血症，47 例（占病毒血症患者的 29%，占总患者的 21%）在 HCT 后 1 年内进行了 CMV 耐药性检测。19 例（占病毒血症患者的 12%，占总患者的 9%）患者被确认为 CMV 耐药，90%的患者在 HCT 后 3 个月以上被发现耐药。12 例患者仅 UL97 有突变；其余 7 例患者仅 UL54 有突变或 UL54 和 UL97 均有突变。至 HCT 后 1 年，19 例有突变的患者中有 11 例（58%）发生了 CMV 终末器官疾病。耐药患者中与 CMV 相关的死亡率为 42%。
结论
在 CD34 选择的 HCT 受者中，9%的 CMV R+患者在 HCT 后 1 年出现 CMV 耐药。在 19 例 CMV 耐药患者中，58%发生了 CMV 终末器官疾病，42%死于 CMV。对于 CD34 选择的 HCT，需要有效的 CMV 预防策略和恢复 CMV 免疫力的方法。
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