[Cytomegalovirus diseases after allogeneic hematopoietic stem cell transplantation (Allo-HSCT) and related risk factors].Zhonghua Yi Xue Za Zhi. 2003 May 10; 83(9):766-9.ZY
To analyze the incidence of cytomegalovirus (CMV) diseases after allogeneic hematopoietic stem cell transplantation (allo-HSCT) and related risk factors.
The clinical data of 131 patients undergoing allo-HSCT August 1999 to July 2001 were analyzed retrospectively.
Twenty-eight of the 131 patients developed CMV interstitial pneumonia (IP) with an incidence rate of 21.35%, 9 patients developed CMV enteritis with an incidence rate of 6.87%; in total 37 of the 131 patients developed CMV disease with the accumulative one-year incidence rate of 32.54%. Thirteen patients (35.14%)died of CMV diseases. Univariate analysis showed that accumulative incidence of CMV disease was associated with unrelated donor, II-IV degrees acute graft versus host disease (aGVHD), additional immunosuppressive therapy for GVHD, chronic graft versus host disease (cGVHD), antilymphocyte globulin (ALG)/monoclonal antibody (MoAb) administration, high dose of methylprednisolone (MP), plasma viramia-PCR (PV-PCR) positivity of patients, blood transfusion and pre-emptive treatment. Multivariate analysis showed that risk factors for CMV disease included plasma CMV-DNA positivity, immense amount of blood transfused, and additional immunosuppressive therapy for aGVHD, and pre-emptive therapy capable of turning PV-PCR positive reduced the incidence of CMV disease (RR: 3.309, 1.046, 2.242, and 0.346).
CMV disease has a high morbidity and mortality in allo-HSCT patients. Patients with positive plasma CMV-DNA should receive pre-emptive therapy till their plasma CMV-DNA turns to be negative, especially in condition of severe aGVHD, immense amount of blood transfused, or additional immunosuppressive therapy.