Department of Medicine and Biosystemic Science, Kyushu University Graduate School of Medical Sciences, Fukuoka, 812-8582, Japan.
Department of Hematology, Clinical Immunology and Infectious Diseases, Ehime University Graduate School of Medicine, Toon, Ehime, 791-0295, Japan.
Int J Hematol. 2022 Jan;115(1):96-106. doi: 10.1007/s12185-021-03218-3. Epub 2021 Oct 15.
Post-transplant cytomegalovirus (CMV) disease can be almost completely avoided by current infection control procedures. However, CMV reactivation occurs in more than half of patients, and some patients can develop clinically resistant CMV infections. Whether resistance is due to the host's immune status or a viral resistance mutation is challenging to confirm. Therefore, a prospective observational analysis of refractory CMV infection was conducted in 199 consecutive patients who received allogeneic hematopoietic stem cell transplantation at a single institution. Among them, 143 (72%) patients received anti-CMV drugs due to CMV reactivation, and only 17 (8.5%) exhibited refractory CMV infection. These patients had clinically refractory infection. However, viral genome analysis revealed that only one patient exhibited a mutation associated with the anti-CMV drug resistance. Clinical resistance was mainly correlated with host immune factors, and the incidence of resistance caused by gene mutations was low at the early stage after a transplantation.
通过目前的感染控制措施，几乎可以完全避免移植后巨细胞病毒（CMV）疾病。然而，超过一半的患者会出现 CMV 再激活，一些患者会发展为临床耐药的 CMV 感染。确定耐药性是由于宿主的免疫状态还是病毒耐药突变具有挑战性。因此，对在单一机构接受异基因造血干细胞移植的 199 例连续患者进行了难治性 CMV 感染的前瞻性观察分析。其中，143 例（72%）患者因 CMV 再激活而接受抗 CMV 药物治疗，仅有 17 例（8.5%）患者出现难治性 CMV 感染。这些患者的 CMV 感染具有临床耐药性。然而，病毒基因组分析显示，只有 1 例患者表现出与抗 CMV 药物耐药相关的突变。临床耐药性主要与宿主免疫因素相关，在移植后早期，由基因突变引起的耐药性发生率较低。
