Division of Infectious Diseases, Department of Internal Medicine, Seoul St. Mary's Hospital, Catholic Hematology Hospital, Vaccine Bio Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Department of Haematology, Istanbul University-Cerrahpasa, Cerrahpassa Medical Faculty, Istanbul, Turkey.
Transpl Infect Dis. 2023 Aug;25(4):e14083. doi: 10.1111/tid.14083. Epub 2023 Jun 8.
Cytomegalovirus (CMV) disease impacts morbidity and mortality in hematopoietic cell transplant (HCT) recipients. This systematic review summarized data on the epidemiology, management, and burden of CMV post-HCT outside of Europe and North America.
The MEDLINE, Embase, and Cochrane databases were searched for observational studies and treatment guidelines in HCT recipients across 15 selected countries from Asia-Pacific, Latin America, and Middle East (search period: 1 January 2011-17 September 2021). Outcomes included incidence of CMV infection/disease, recurrence, risk factors, CMV-related mortality, treatments, refractory, resistant CMV, and burden.
Of 2708 references identified, 68 were eligible (67 studies and one guideline; 45/67 studies specific to adult allogeneic HCT recipients). The rates of CMV infection and disease within 1 year of allogeneic HCT were 24.9%-61.2% (23 studies) and 2.9%-15.7% (10 studies), respectively. Recurrence occurred in 19.8%-37.9% of cases (11 studies). Up to 10% of HCT recipients died of CMV-related causes. In all countries, first-line treatment for CMV infection/disease involved intravenous ganciclovir or valganciclovir. Conventional treatments were associated with serious adverse events such as myelosuppression (10.0%) or neutropenia only (30.0%, 39.8%) and nephrotoxicity (11.0%) (three studies), frequently leading to treatment discontinuation (up to 13.6%). Refractory CMV was reported in 2.9%, 13.0%, and 28.9% of treated patients (three studies) with resistant CMV diagnosed in 0%-10% of recipients (five studies). Patient-reported outcomes and economic data were scarce.
The incidence of CMV infection and disease post-HCT is high outside of North America and Europe. CMV resistance and toxicity highlight a major unmet need with current conventional treatments.
巨细胞病毒（CMV）疾病会影响造血细胞移植（HCT）受者的发病率和死亡率。本系统综述总结了除欧洲和北美以外的亚太地区、拉丁美洲和中东地区 15 个选定国家的 HCT 受者中 CMV 感染后的流行病学、治疗和负担数据。
在 MEDLINE、Embase 和 Cochrane 数据库中检索了 2011 年 1 月至 2021 年 9 月 17 日期间来自亚太地区、拉丁美洲和中东地区的 15 个选定国家的 HCT 受者的观察性研究和治疗指南。研究结果包括 CMV 感染/疾病的发生率、复发率、危险因素、CMV 相关死亡率、治疗方法、难治性、耐药性 CMV 和负担。
在 2708 篇参考文献中，有 68 篇符合纳入标准（67 项研究和 1 项指南；45/67 项研究专门针对成人异基因 HCT 受者）。异基因 HCT 后 1 年内 CMV 感染和疾病的发生率分别为 24.9%-61.2%（23 项研究）和 2.9%-15.7%（10 项研究）。复发率为 19.8%-37.9%（11 项研究）。多达 10%的 HCT 受者死于 CMV 相关原因。在所有国家，CMV 感染/疾病的一线治疗均涉及静脉注射更昔洛韦或缬更昔洛韦。常规治疗与骨髓抑制（10.0%）或中性粒细胞减少（仅 30.0%，39.8%）和肾毒性（11.0%）等严重不良事件相关（三项研究），并经常导致治疗中断（高达 13.6%）。难治性 CMV 在接受治疗的患者中报告为 2.9%、13.0%和 28.9%（三项研究），耐药性 CMV 在接受治疗的患者中诊断为 0%-10%（五项研究）。患者报告的结局和经济数据稀缺。
在北美和欧洲以外地区，HCT 后 CMV 感染和疾病的发生率很高。CMV 耐药性和毒性突出了目前常规治疗的一个主要未满足需求。
