Su Nan, Liu Zhenghua, Sun Peng, Gu Feng, Yan Xiaojing, Cai Dali
Department of Hematology, The First Hospital of China Medical University, Shenyang, Liaoning, China.
Department of Ophthalmology, The First Hospital of China Medical University, Shenyang, Liaoning, China.
Front Med (Lausanne). 2022 Sep 6;9:948210. doi: 10.3389/fmed.2022.948210. eCollection 2022.
Drug-resistant cytomegalovirus (CMV) infection after hematopoietic stem cell transplantation (HSCT) often leads to morbidity and mortality. Several studies have shown that CMV-cytotoxic T lymphocytes (CTLs) can overcome drug-resistant CMV infection, but still many questions remain unanswered. Here, we present a case of refractory CMV infection after allogeneic HSCT (allo-HSCT). Donor-derived CMV-CTLs failed to eliminate the virus in unique peripheral blood on the first application, when 70 mg methylprednisolone (MP) was taken per day. After a second attempt with a combination of 8 mg MP with leflunomide, a complete and persisting clearance of all involved sites, including peripheral blood, urinary system, leptomeninges, and retina, was achieved. To summarize, intravenous infusion of CTLs can eliminate CMV in the oculi and central nervous system (CNS), and a low dosage of 8 mg MP has no interaction with CMV-CTLs.
造血干细胞移植（HSCT）后耐药巨细胞病毒（CMV）感染常导致发病和死亡。多项研究表明，CMV细胞毒性T淋巴细胞（CTL）可克服耐药CMV感染，但仍有许多问题未得到解答。在此，我们报告1例异基因HSCT（allo-HSCT）后难治性CMV感染病例。首次应用时，供体来源的CMV-CTL未能清除独特外周血中的病毒，当时每天服用70mg甲泼尼龙（MP）。在第二次尝试使用8mg MP与来氟米特联合治疗后，实现了包括外周血、泌尿系统、软脑膜和视网膜在内的所有受累部位的完全且持续清除。总之，静脉输注CTL可清除眼部和中枢神经系统（CNS）中的CMV，低剂量8mg MP与CMV-CTL无相互作用。
