单倍体造血干细胞移植患者巨细胞病毒感染的临床特点分析
Clinical analysis in cytomegalovirus infection after haploidentical hematopoietic stem cell transplantation
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摘要: 目的 分析单倍体异基因外周血造血干细胞移植(allogene peripheral blood stem cell transplantation,Allo-PBSCT)患者巨细胞病毒(cytomegalovirus,CMV)感染的临床特点。方法 选取2013年10月-2018年1月华北理工大学附属医院38例行单倍体Allo-PBSCT患者为研究对象。其中男16例,女22例;平均年龄33(11~54)岁;急性髓系白血病(acute myeloid leukemia,AML)16例,慢性粒细胞白血病(chronic myeloid leukemia,CML)4例,骨髓增生异常综合征(myelodysplastic syndrome,MDS)4例,急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)14例。患者均给予改良马利兰/环磷酰胺(BU/CY)预处理方案,血细胞植活后动态监测外周血CMV-DNA数值,及时启动抗病毒治疗,分析CMV感染发生及转归情况、危险因素等。结果 移植患者CMV感染发生率为73.7%,发生中位时间为移植后38(14~94) d。抗病毒治疗后,CMV感染转阴率为89.3%,CMV病发生率为3.6%。单因素分析显示,CMV感染与移植物抗宿主病(graft versus host disease,GVHD)的发生有明显相关性(P<0.05),移植术后发生GVHD组CMV感染率更高。结论 单倍体造血干细胞移植后CMV感染发生率较高,GVHD的发生与CMV感染相关。Abstract: Objective To analyze the clinical characteristics of cytomegalovirus(CMV) infection after haploid allogene peripheral blood stem cell transplantation(Allo-PBSCT). Methods From October 2013 to January 2018, 38 patients undergoing haploid AlloPBSCT were pretreated with modified BU/CY regimen in our hospital. There were 16 males and 22 females, with an average age of 33(11-54) years; 16 cases had acute myeloid leukemia(AML), 4 cases had chronic myeloid leukemia(CML), 4 cases had myelodysplastic syndrome(MDS), and 14 cases had acute lymphoblastic leukemia(ALL). CMV-DNA values were dynamically monitored after blood cell transplantation and antiviral therapy was timely initiated. The incidence and prognosis of CMV infection and its risk factors were analyzed. Results The incidence of CMV infection was 73.7%, and the median time to onset of CMV infection was 38(14-94) days after implantation. After antiviral therapy, the seroconversion rate of CMV infection was 89.3% and the CMV disease incidence was 3.6%. Univariate analysis showed that CMV infection was associated with the occurrence of graft versus host disease(GVHD)(P< 0.05). The incidence of CMV infection in GVHD group was higher after transplantation. Conclusion The incidence of CMV infection after haploid stem cell transplantation is high, and the occurrence of GVHD is associated with CMV infection.
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