Division of Infectious Diseases, University Hospital of Geneva, Geneva, Switzerland.
Division of Hematology, Bone Marrow Transplant Unit, University Hospital of Geneva, Geneva, Switzerland.
Immun Inflamm Dis. 2021 Sep;9(3):771-776. doi: 10.1002/iid3.431. Epub 2021 May 5.
Letermovir prophylaxis in allogeneic hematopoietic cell transplant recipients significantly reduces the incidence of clinically significant cytomegalovirus infection. However, breakthrough infections still occur despite adequate prophylaxis. In the present retrospective cohort study, we identified clinically relevant predictive factors for clinically significant CMV breakthrough infection during letermovir prophylaxis. Low-grade CMV replication (21-149 IU/ml), both at the time of letermovir initiation or during prophylaxis, was a significant risk factor for breakthrough clinically significant CMV infection. In addition, development of acute gastrointestinal graft-versus-host disease was significantly associated with breakthrough infection. Altogether these findings could call clinicians' attention to closer CMV monitoring and allow for prompt preemptive treatment initiation.
更昔洛韦预防治疗显著降低异基因造血细胞移植受者发生临床显著的巨细胞病毒感染的发生率。然而，尽管进行了充分的预防治疗，突破性感染仍会发生。在本回顾性队列研究中，我们确定了在更昔洛韦预防治疗期间发生临床显著 CMV 突破性感染的相关预测因素。在开始更昔洛韦治疗时或预防治疗期间，低水平的 CMV 复制（21-149IU/ml）是突破性感染的显著危险因素。此外，急性胃肠道移植物抗宿主病的发生与突破性感染显著相关。综上所述，这些发现可能会引起临床医生对更密切的 CMV 监测的关注，并能够及时启动抢先治疗。
