Devasia Anup J, Mammen Shoba, Korula Anu, Abraham Aby, Fouzia N A, Lakshmi Kavitha M, Abraham Asha Mary, Srivastava Alok, Mathews Vikram, George Biju
1Department of Clinical Hematology, Christian Medical College, Vellore, India.
2Department of Clinical Virology, Christian Medical College, Vellore, India.
Indian J Hematol Blood Transfus. 2018 Oct;34(4):636-642. doi: 10.1007/s12288-018-0960-y. Epub 2018 Apr 16.
Cytomegalovirus (CMV) infection remains an important cause of morbidity and mortality following allogeneic stem cell transplantation (SCT). We wanted to study if the high sero-prevalence seen in our population translated into a high incidence of CMV infection following SCT. This is a retrospective analysis of patients who underwent allogeneic SCT between January 2008 and December 2012 at our centre. 475 patients underwent allogeneic SCT for malignant (46.5%) and non-malignant (53.5%) haematological disorders. 463 (97.4%) SCT recipients and 403 (84.8%) SCT donors were IgG seropositive for CMV. CMV reactivation within 100 days post SCT was seen in 174 (36.6%) at a median of 41 days (range 10-100) post SCT. Ganciclovir was used in 166 patients (95.4%) for a mean duration of 16 days (range 5-32). 157 patients (90%) responded to therapy. Sixty-six patients (42.3%) had secondary reactivation of the virus. Use of a male donor ( = 0.000), donor and recipient age > 15 ( = 0.005 and 0.000), unrelated donor ( = 0.000), degree of HLA mismatch ( = 0.000), occurrence of acute GVHD ( = 0.000) and steroid refractory acute GVHD ( = 0.026) were identified as risk factors for CMV reactivation while early neutrophil recovery (< 15 days) was found to be protective ( = 0.004). On multivariate analysis, male donor ( = 0.042), degree of HLA mismatch ( = 0.006), the occurrence of acute GVHD ( = 0.000) and steroid refractory acute GVHD ( = 0.031) continued to remain significant. 5-year overall survival was significantly better in patients without CMV reactivation compared to those who developed reactivation of CMV (68.9 ± 3.7 vs 58.2 ± 4.9% = 0.004). The incidence of CMV infection does not seem to be higher despite a high sero-prevalence of CMV. However, patients who developed CMV infection post SCT had inferior outcomes.
巨细胞病毒（CMV）感染仍然是异基因造血干细胞移植（SCT）后发病和死亡的重要原因。我们想研究在我们的人群中观察到的高血清阳性率是否会转化为SCT后CMV感染的高发病率。这是一项对2008年1月至2012年12月在我们中心接受异基因SCT的患者的回顾性分析。475例患者因恶性（46.5%）和非恶性（53.5%）血液系统疾病接受了异基因SCT。463例（97.4%）SCT受者和403例（84.8%）SCT供者CMV IgG血清学阳性。174例（36.6%）患者在SCT后100天内出现CMV再激活，中位时间为SCT后41天（范围10 - 100天）。166例患者（95.4%）使用了更昔洛韦，平均使用时间为16天（范围5 - 32天）。157例患者（90%）对治疗有反应。66例患者（42.3%）出现病毒继发再激活。使用男性供者（P = 0.000）、供者和受者年龄>15岁（P = 0.005和0.000）、无关供者（P = 0.000）、HLA错配程度（P = 0.000）、急性移植物抗宿主病（GVHD）的发生（P = 0.000）和类固醇难治性急性GVHD（P = 0.026）被确定为CMV再激活的危险因素，而早期中性粒细胞恢复（<15天）具有保护作用（P = 0.004）。多因素分析显示，男性供者（P = 0.042）、HLA错配程度（P = 0.006）、急性GVHD的发生（P = 0.000）和类固醇难治性急性GVHD（P = 0.031）仍然具有显著性。与发生CMV再激活的患者相比，未发生CMV再激活的患者5年总生存率显著更好（68.9±3.7% vs 58.2±4.9%，P = 0.004）。尽管CMV血清阳性率很高，但CMV感染的发病率似乎并不更高。然而，SCT后发生CMV感染的患者预后较差。
