Service de Neurologie, Hôpital Saint Louis, Assistance Publique-Hôpitaux de Paris (AP-HP.Nord), Paris, France.
Université de Paris, Paris, France.
J Neurovirol. 2021 Feb;27(1):94-100. doi: 10.1007/s13365-020-00922-4. Epub 2021 Jan 6.
The human cytomegalovirus (HCMV) is a ubiquitous herpes virus which infects 40 to 99% of the population. HCMV reactivation may occur in the context of immunosuppression and can induce significant morbidities. Several cases of HCMV infections or HCMV reactivation have thus been reported in glioblastoma (GBM) patients treated with radio(chemo)therapy. With the aim to identify the main risk factors associated with HCMV reactivation, we reviewed all patients treated for a newly diagnosed GBM in our institution from October 2013 to December 2015. Age, sex, Karnofsky performance status (KPS), absolute lymphocyte count (ALC), serological HCMV status, and steroid doses were recorded at the start and 1 month after the end of radiotherapy (RT). Within the 103 patients analyzed, 34 patients (33%) had an initial negative serology for HCMV, and none of them developed a seroconversion after treatment. Among patients with positive HCMV IgG (n = 69), 16 patients (23%) developed a viremia at one point during treatment. Age (> 60 years), steroid intake, and ALC (< 1500/mm) before RT were correlated with HCMV reactivation. HCMV viremia was associated with neurological decline 1 month after chemoradiotherapy but progression-free survival was not impacted. A shorter overall survival was seen in these patients when compared with the others, but this could be biased by the older age in this subgroup. HCMV reactivation needs to be sought in case of a neurological decline during RT especially in older patients treated with steroids and low lymphocytes counts.
人巨细胞病毒（HCMV）是一种普遍存在的疱疹病毒，感染了 40%至 99%的人群。HCMV 再激活可能发生在免疫抑制的情况下，并可能导致显著的发病率。因此，在接受放化疗治疗的胶质母细胞瘤（GBM）患者中，已经报道了几例 HCMV 感染或 HCMV 再激活的病例。为了确定与 HCMV 再激活相关的主要危险因素，我们回顾了 2013 年 10 月至 2015 年 12 月在我们机构接受新诊断的 GBM 治疗的所有患者。在开始和放疗结束后 1 个月记录年龄、性别、卡诺夫斯基表现状态（KPS）、绝对淋巴细胞计数（ALC）、血清 HCMV 状态和类固醇剂量。在分析的 103 例患者中，34 例（33%）患者的初始 HCMV 血清学为阴性，且无一例在治疗后发生血清转换。在 HCMV IgG 阳性的患者中（n=69），有 16 例（23%）在治疗期间出现 HCMV 血症。年龄（>60 岁）、类固醇摄入和放疗前的 ALC（<1500/mm）与 HCMV 再激活相关。HCMV 血症与放化疗后 1 个月的神经功能下降有关，但无进展生存期不受影响。与其他患者相比，这些患者的总生存期较短，但这可能因该亚组的年龄较大而存在偏差。在放疗期间出现神经功能下降时，尤其是在接受类固醇和低淋巴细胞计数治疗的老年患者中，需要寻找 HCMV 再激活的迹象。
