Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic AreaHsin - Chen Lin1, Shao - Min Han1, Wen - Li Hwang1, Cheng - Wei Chou1, Kuang - Hsi Chang2, Zhi - Yuan Shi3, Chieh-lin Jerry Teng41Taichung Veterans General Hospital, Department of Medicine, Division of Hematology-Medical Oncology, Taichung, Taiwan
2China Medical University, Department of Public Health, Taichung, Taiwan
3Taichung Veterans General Hospital Division of Infectious Diseases, Department of Medicine, Taichung, Taiwan
4Taichung Veterans General Hospital, Department of Medicine, Division of Hematology-Medical Oncology, Taichung, Taiwan, Tunghai University, Department of Life Science, Tunghai, Taichung, Taiwan, Chung Shan Medical University Faculty of Medicine, Division of Hematology, Taichung, Taiwan
Objective: Although Cytomegalovirus (CMV) infection is a major complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT), the risk factors for CMV reactivation and treatment failure in CMV endemic areas have remained unclear. This study investigated the risk factors for CMV reactivation among allo-HSCT recipients in an area where CMV is highly endemic.
Materials and Methods: Medical records of 82 allo-HSCT recipients from a CMV endemic area were retrospectively reviewed. The patients were stratified into two groups: those with CMV reactivation (n=32) and those without CMV reactivation (n=50). We investigated possible variables associated with CMV reactivation and treatment failure.
Results: Univariate analyses showed that non-remission disease status [hazard ratio (HR): 2.15; p=0.032] and ≥grade III acute graftversus- host disease (GVHD) (HR: 3.07; p=0.002) were associated with CMV reactivation. Multivariate analysis further demonstrated that older age (HR: 1.03; p=0.029) and ≥grade III acute GVHD (HR: 2.98; p=0.012) were associated with CMV reactivation. Overall survival time seemed lower among patients with CMV reactivation than among patients without CMV reactivation, although the difference was not statistically significant (p=0.165). The absence of ≥grade III acute GVHD was associated with successful CMV treatment in the current study (odds ratio: 4.40; p=0.008).
Conclusion: Prophylactic anti-CMV therapy might need to be considered for allo-HSCT recipients who have ≥grade III GVHD.
Keywords: Allogeneic hematopoietic stem cell transplantation, Cytomegalovirus, Graft-versus-host disease, Taiwan
Allojeneik Hematopoietik Kök Hücre Transplantasyonunda Sitomegalovirüs Enfeksiyonu ve Tedavisi: Endemik Bir Alanda Tek Merkezden Retrospektif Bir ÇalışmaHsin - Chen Lin1, Shao - Min Han1, Wen - Li Hwang1, Cheng - Wei Chou1, Kuang - Hsi Chang2, Zhi - Yuan Shi3, Chieh-lin Jerry Teng41Taichung Veterans General Hospital, Department of Medicine, Division of Hematology-Medical Oncology, Taichung, Taiwan
2China Medical University, Department of Public Health, Taichung, Taiwan
3Taichung Veterans General Hospital Division of Infectious Diseases, Department of Medicine, Taichung, Taiwan
4Taichung Veterans General Hospital, Department of Medicine, Division of Hematology-Medical Oncology, Taichung, Taiwan, Tunghai University, Department of Life Science, Tunghai, Taichung, Taiwan, Chung Shan Medical University Faculty of Medicine, Division of Hematology, Taichung, Taiwan
Amaç: Sitomegalovirüs (CMV) enfeksiyonu, allojeneik kök hücre transplantasyonu (allo-KHT) sonrası majör bir komplikasyon olmasına rağmen CMV’nin endemik olduğu alanlarda CMV reaktivasyonu ve tedavi başarısızlığı için risk faktörleri belirsizliğini korumaktadır. Bu çalışma CMV’nin büyük ölçüde endemik olduğu bir alanda allo-KHT alıcılarında CMV reaktivasyonu için risk faktörlerini araştırmıştır.
Gereç ve Yöntem: CMV endemik olduğu bir alandan 82 allo-KHN alıcısının tıbbi kayıtları retrospektif olarak incelendi. Hastalar iki gruba ayrıldı: CMV reaktivasyonu olan (n=32) ve CMV reaktivasyonu olmayan (n=50). CMV reaktivasyonu ve tedavi başarısızlığı ile ilişkili olası değişkenler araştırıldı.
Bulgular: Tek değişkenli analiz CMV reaktivasyonunun remisyonolmayan hastalık durumu [risk oranı (RO): 2,15; p=0,032) ve ≥grade III akut graft versus host hastalığı (GVHH) (RO: 3,07; p=0,002) ile ilişkili olduğunu gösterdi. Çok değişkenli analiz ayrıca CMV reaktivasyonunun ileri yaş (RO: 1,03; p=0,029) ve ≥grade III akut GVHH (RO: 2,98; p=0,012) ile ilişkili olduğunu gösterdi. Genel sağkalım CMV reaktivasyonu olan hastalarda CMV reaktivasyonu olmayan hastalardan daha düşük görünmekle birlikte fark istatistiksel olarak anlamlı değildi (p=0,165). Bu çalışmada, ≥grade III akut GVHH yokluğu başarılı CMV tedavisi ile ilişkili idi (olasılık oranı: 4,40; p=0,008).
Sonuç: Profilaktik anti-CMV tedavisinin ≥grade III GVHH olan allo- KHT alıcılarında dikkate alınması gerekebilir.
Anahtar Kelimeler: Allojeneik hematopoietik kök hücre transplantasyonu, Sitomegalovirüs, Graft versus host hastalığı, Tayvan
Hsin - Chen Lin, Shao - Min Han, Wen - Li Hwang, Cheng - Wei Chou, Kuang - Hsi Chang, Zhi - Yuan Shi, Chieh-lin Jerry Teng. Cytomegalovirus Infection and Treatment in Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Study from a Single Institution in an Endemic Area. Turk J Hematol. 2017; 34(2): 159-166
Corresponding Author: Hsin - Chen Lin, Taiwan |
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