Geurten Claire, Ghinai Rosanna, Munford Haydn, Lawson Sarah
Department of Paediatric Haematology and Oncology, University Hospital of Liège, Liège, Belgium.
Department of Paediatric Stem Cell Transplant, Birmingham Women and Children's NHS Foundation Trust.
J Pediatr Hematol Oncol. 2023 Jan 1;45(1):e82-e86. doi: 10.1097/MPH.0000000000002553. Epub 2022 Sep 22.
Cytomegalovirus (CMV) infection is a serious complication of pediatric hematopoietic stem cell transplant (HSCT). To date, antiviral therapy has been the mainstay of prophylaxis, with conflicting results regarding the benefits of CMV-specific immunoglobulins (CMV-Ig). After introducing prophylactic CMV-Ig to HSCT recipients at risk (seropositive recipient and/or donor), we conducted a single-center retrospective study comparing the incidence and severity of CMV infection with and without CMV-Ig. We identified 49 'at risk' recipients from 76 consecutive HSCTs over 3.5 years, in addition to standard antiviral prophylaxis, 10 patients received CMV-Ig and 39 did not. There was no significant difference in donor type, cell source, conditioning, or CMV status between the groups. We observed a potential trend toward reduction of incidence of CMV reactivation in patients exposed to CMV-Ig (30%) compared with those who weren't (38.4%). Besides, no symptomatic or lethal infection was observed in the CMV-Ig group, and time to recovery seemed shorter (21 [±7] vs 51.4 [±55] days) and peak titers lower (4578 [±4788] vs 24131 [±49257]) with CMV-Ig. No adverse events were noted. The statistical significance of the results was limited by the small sample size. These data raise interest in prophylactic CMV-Ig as a safe way of potentially reducing the severity and duration of CMV reactivation in HSCT.
巨细胞病毒（CMV）感染是小儿造血干细胞移植（HSCT）的一种严重并发症。迄今为止，抗病毒治疗一直是预防的主要手段，关于CMV特异性免疫球蛋白（CMV-Ig）的益处存在相互矛盾的结果。在将预防性CMV-Ig引入有风险的HSCT受者（血清反应阳性的受者和/或供者）后，我们进行了一项单中心回顾性研究，比较了使用和不使用CMV-Ig时CMV感染的发生率和严重程度。我们从3.5年期间连续进行的76例HSCT中确定了49例“有风险”的受者，除了标准的抗病毒预防措施外，10例患者接受了CMV-Ig，39例未接受。两组之间在供者类型、细胞来源、预处理或CMV状态方面没有显著差异。我们观察到，与未接触CMV-Ig的患者（38.4%）相比，接触CMV-Ig的患者CMV再激活发生率有降低的潜在趋势（30%）。此外，CMV-Ig组未观察到有症状或致命感染，且恢复时间似乎更短（21[±7]天对51.4[±55]天），CMV-Ig组的峰值滴度更低（457起[±4788]对24131[±49257]）。未观察到不良事件。由于样本量小，结果的统计学意义有限。这些数据引发了人们对预防性CMV-Ig作为一种可能降低HSCT中CMV再激活的严重程度和持续时间的安全方法的兴趣。
