Comparison of different cytomegalovirus diseases following haploidentical hematopoietic stem cell transplantation
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ORIGINAL ARTICLE
Comparison of different cytomegalovirus diseases following haploidentical hematopoietic stem cell transplantation Xing-Ye Meng 1,2,3,4 & Hai-Xia Fu 1,2,3,4 & Xiao-Lu Zhu 1,2,3,4 & Jing-Zhi Wang 1,2,3,4 & Xiao Liu 1,2,3,4 & Chen-Hua Yan 1,2,3,4 & Yuan-Yuan Zhang 1,2,3,4 & Xiao-Dong Mo 1,2,3,4 & Yu Wang 1,2,3,4 & Wei Han 1,2,3,4 & Yu-Hong Chen 1,2,3,4 & Ding-Bao Chen 5 & Hui-Xin Liu 6 & Ying-Jun Chang 1,2,3,4 & Lan-Ping Xu 1,2,3,4 & Kai-Yan Liu 1,2,3,4 & Xiao-Jun Huang 1,2,3,4 & Xiao-Hui Zhang 1,2,3,4 Received: 6 May 2020 / Accepted: 24 July 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Cytomegalovirus (CMV) can cause end-organ diseases including pneumonia, gastroenteritis, retinitis, and encephalitis in hematopoietic stem cell transplantation recipients. Potential differences among different CMV diseases remain uncertain. This study aimed to compare the clinical characteristics, risk factors, and mortality among different CMV diseases. A retrospective nested case-control study was performed based on a cohort of 3862 patients who underwent haploidentical hematopoietic stem cell transplantation at a single-center. CMV diseases occurred in 113 (2.92%) of 3862 haplo-HSCT recipients, including probable CMV pneumonia (CMVP, n = 34), proven CMV gastroenteritis (CMVG, n = 34), CMV retinitis (CMVR, n = 31), probable CMV encephalitis (CMVE, n = 7), and disseminated CMV disease (Di-CMVD, n = 7). Most (91.2%) cases of CMVG developed within 100 days, while most (90.3%) cases of CMVR were late onset. Refractory CMV infection and CMV viral load at different levels were associated with an increased risk of CMVP, CMVG, and CMVR. Compared with patients without CMV diseases, significantly higher non-relapse mortality at 1 year after transplantation was observed in patients with CMVP and CMVR, rather than CMVG. Patients with CMVP, Di-CMVD, and CMVE had higher overall mortality after diagnosis than that of patients with CMVG and CMVR (61.7%, 57.1%, 40.0% vs 27.7%, 18.6%, P = 0.001). In conclusion, the onset time, viral dynamics, and mortality differ among different CMV diseases. The mortality of CMV diseases remains high, especially for CMVP, Di-CMVD, and CMVE. Keywords CMV diseases . Viral dynamics . CMV infection . Haploidentical hematopoietic stem cell transplantation
Introduction Cytomegalovirus (CMV) infection remains an important cause of morbidity and mortality in patients who undergo allogeneic hematopoietic stem cell transplant (allo-HSCT)
[1–3]. Invasive CMV infections are characterized as endorgan diseases, including CMV pneumonia (CMVP), CMV gastroenteritis (CMVG), CMV retinitis (CMVR), CMV encephalitis (CMVE), and disseminated CMV disease (DiCMVD) [1, 4, 5]. CMV infection is a potential challenge for
Xing-Ye Meng, Hai-Xia Fu and Xiao-Lu Zhu contributed equally to this work. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00277-020-04201-4) contains supplementary material, which is available to authorized users. * Xiao-Hui Zhang
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