未接受造血干细胞移植的恶性淋巴瘤患者的巨细胞病毒感染。
Cytomegalovirus infection in patients with malignant lymphomas who have not received hematopoietic stem cell transplantation.
机构信息
Department of Hematology/Oncology, Asahikawa Kosei Hospital, 1-24, Asahikawa, 078-8211, Japan.
Division of Metabolism and Biosystemic Science, Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, Asahikawa, Japan.
出版信息
BMC Cancer. 2022 Sep 1;22(1):944. doi: 10.1186/s12885-022-10008-5.
BACKGROUND
Life-threatening cytomegalovirus infection (CMVI) has been reported even in patients with malignant lymphoma (ML) who have not received hematopoietic stem cell transplantation (w/o HSCT) but had been treated with chemotherapy or radiotherapy. However, the CMVI incidence and risk factors (RFs) in patients with ML w/o HSCT have not been fully elucidated. This study aimed to evaluate the clinical aspects, including incidence and RFs, of CMVI in patients with ML w/o HSCT.
METHODS
We retrospectively reviewed all patients with ML who received chemotherapy or radiotherapy in our department from 2005 to 2013. The overall survival (OS), incidence and RFs of CMVI, and other characteristics of patients with CMVI were analyzed.
RESULTS
Overall, 236 patients with ML w/o HSCT were evaluated. Of these, 5.5% (13/236) developed CMVI; 54% (7/13) received steroid pretreatment before primary therapy (PT) for ML; and 62% (8/13) received > 2 therapeutic regimens for ML. The OS curve of patients with CMVI was significantly worse than that of patients without CMVI (p < 0.0001, log-rank test). A univariate analysis identified B symptoms (p = 0.00321), serum albumin < 3.5 g/dL (p = 0.0007837), C-reactive protein level > the upper limit of normal (p = 0.0006962), steroid pretreatment before PT for ML (p = 0.0004262), > 2 therapeutic regimens for ML (p = 0.0000818), T cell lymphoma (p = 0.006406), and non-complete remission (p = 0.02311) as RFs for CMVI. A multivariate analysis identified steroid pretreatment before PT for ML [odds ratio (OR): 4.71 (95% confidence interval [CI]: 1.06-21.0); p = 0.0419] and > 2 therapeutic regimens for ML [OR: 9.25 (95% CI: 2.33-36.8); p = 0.00159] as independent RFs for CMVI in patients with ML w/o HSCT.
CONCLUSIONS
Attention should be paid to CMVI development in patients with ML w/o HSCT pretreated with steroids or who had multiple therapeutic regimens.
背景
即使在未接受造血干细胞移植（HSCT）但接受过化疗或放疗的恶性淋巴瘤（ML）患者中，也有危及生命的巨细胞病毒感染（CMVI）的报道。然而，ML 患者未接受 HSCT 时 CMVI 的发生率和危险因素（RFs）尚未完全阐明。本研究旨在评估 ML 患者未接受 HSCT 时 CMVI 的临床特征，包括发生率和 RFs。
方法
我们回顾性分析了 2005 年至 2013 年在我科接受化疗或放疗的所有 ML 患者。分析了 CMVI 的总生存率（OS）、发生率和 RFs 以及 CMVI 患者的其他特征。
结果
共有 236 例 ML 患者未接受 HSCT 治疗，其中 5.5%（13/236）发生 CMVI；54%（7/13）在接受 ML 初始治疗（PT）前接受类固醇预处理；62%（8/13）接受了超过 2 种 ML 治疗方案。CMVI 患者的 OS 曲线明显差于无 CMVI 患者（p<0.0001，对数秩检验）。单因素分析发现有 B 症状（p=0.00321）、血清白蛋白<3.5 g/dL（p=0.0007837）、C 反应蛋白水平>正常值上限（p=0.0006962）、ML 初始治疗前接受类固醇预处理（p=0.0004262）、接受超过 2 种 ML 治疗方案（p=0.0000818）、T 细胞淋巴瘤（p=0.006406）和非完全缓解（p=0.02311）为 CMVI 的 RFs。多因素分析发现，ML 初始治疗前接受类固醇预处理（OR：4.71[95%置信区间（CI）：1.06-21.0]；p=0.0419）和接受超过 2 种 ML 治疗方案（OR：9.25[95%CI：2.33-36.8]；p=0.00159）是 ML 患者未接受 HSCT 时 CMVI 的独立 RFs。
结论
应注意接受类固醇预处理或接受多种治疗方案的 ML 患者发生 CMVI 的情况。
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