异基因造血干细胞移植后巨细胞病毒感染的分层治疗

Stratification therapy for cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation

背景:巨细胞病毒感染是异基因造血干细胞移植后最常见的病毒感染,是影响移植相关死亡率的重要因素。目的:探讨异基因造血干细胞移植后巨细胞病毒感染临床分层治疗方法的疗效。方法:选取60例行异基因造血干细胞移植的患者,依据HLA配型及移植后移植物抗宿主病的发生情况分为低危组18例,中危组30例,高危组12例。应用荧光定量聚合酶链反应监测外周血CMV-DNA数值,结合临床表现及相关试验室检查综合分析,各组于不同时机启动抗病毒治疗。结果与结论:(1)巨细胞病毒感染发生率为63.3%(38/60),发生中位时间为移植后41(14-109) d,经上述分层治疗,巨细胞病毒感染总体转阴率为89.5%(34/38),巨细胞病毒病发生率为2.6%(1/38),巨细胞病毒感染相关死亡率为10.5%(4/38);(2)单因素分析显示,HLA不全相合或移植物抗宿主病的发生可能增加了巨细胞病毒感染的风险;(3)对于异基因造血干细胞移植后巨细胞病毒感染患者,按照HLA配型及移植物抗宿主病的发生情况进行危险度分层,并制定干预治疗体系,减少了抗病毒药物应用及药物相关不良反应,且未增加巨细胞病毒病发生率及巨细胞病毒感染相关死亡率。

BACKGROUND:Cytomegalovirus(CMV)infection is the most common viral infection after transplantation,and it is an important factor affecting transplant-related mortality.OBJECTIVE:To explore the stratified treatment of cytomegalovirus infection after allogeneic hematopoietic stem cell transplantation and analyze its clinical efficacy.METHODS:According to HLA matching and graft-versus-host disease occurrence,60patients with CMV infection undergoing allogeneic peripheral blood stem cell transplantation were assigned into low risk group(n=18),moderate risk group(n=30)and high risk group(n=12).CMV-DNA value was dynamically monitored by quantitative fluorescence PCR.In combination with clinical manifestations and laboratory examinations,antiviral therapy for each group was initialized at different times.RESULTS AND CONCLUSION:The incidence of CMV infection was63.3%(38/60),and the median time was41(14-109)days.After stratified treatment,the negative rate of CMV infection was89.5%(34/38),the incidence of CMV disease was2.6%(1/38),and the CMV related mortality rate was10.5%(4/38).Single factor analysis pointed out that incomplete HLA or graft-versus-host disease graft-versus-host disease probably increased the risk of CMV infection.Therefore,to formulate an interventional treatment for patients with CMV infection who are stratified according to the HLA matching and the occurrence of graft-versus-host disease can reduce the use of antiviral drugs and drug-related adverse reactions,but not increase the incidence of CMV disease and the mortality associated with CMV infection.