背景:巨细胞病毒(CMV)有助于异基因造血细胞移植(allo-HCT)受者的发病率和死亡率。先发制人抗病毒治疗(PET)降低CMV终末器官疾病(EOD)的发生率,尽管启动PET的相关病毒阈值仍未定义。我们评估了PET开始时病毒载量(VL)对儿科allo-HCT后病毒学和临床结果的影响。
方法:对2014年1月至2020年12月首次接受allo-HCT的儿童进行单中心回顾性队列分析。进行每周定量血浆CMV聚合酶链反应直到第+100天,并且一旦VL超过根据机构指南的预定义阈值,就开始PET。患者在HCT后随访1年,以评估病毒学和临床结果,包括终末器官疾病(EOD),总生存期(OS),和非复发死亡率(NRM)。
结果:在146名全HCT接受者中,在HCT后15天的中位数(四分位数范围6-28.5)中,有40名患者(27%)发生了CMVDNA血症。百分之十(n=4)的DNA血症自发消退,而90%(n=36)需要PET。当CMVVL≥1000IU/mL(n=21)与VL<1000IU/mL(n=15)时启动PET导致更高的CMVVL峰(12,670vs.1284IU/mL,p=0.0001)和更长的CMVDNA血症消退时间(36vs.24天,p=0.035)。EOD没有差异,操作系统,或基于PET开始时的VL的HCT后12个月的NRM。
结论:当CMVVL≥1000IU/mL时启动PET可导致明显升高的VL峰和延长的DNA血症,EOD没有差异,操作系统,或NRM在儿科HCT后12个月。
BACKGROUND: Cytomegalovirus (CMV) contributes to morbidity and mortality in allogeneic hematopoietic cell transplantation (allo-HCT) recipients. Pre-emptive antiviral therapy (PET) reduces the incidence of CMV end-organ disease (EOD), though relevant viral thresholds to initiate PET remain undefined. We evaluated the impact of viral loads (VLs) at PET initiation on virologic and clinical outcomes following pediatric allo-HCT.
METHODS: Single-center retrospective cohort analysis of children who underwent their first allo-HCT from January 2014 to December 2020. Weekly quantitative plasma CMV polymerase chain reaction was performed until Day +100 and PET was initiated once VL exceeded a pre-defined threshold per institutional guidelines. Patients were followed for 1-year post-HCT to evaluate virologic and clinical outcomes including end-organ disease (EOD), overall survival (OS), and non-relapse mortality (NRM).
RESULTS: Among 146 allo-HCT recipients, CMV DNAemia occurred in 40 patients (27%) at a median of 15 days post-HCT (interquartile range 6-28.5). Ten percent (n = 4) had spontaneous resolution of DNAemia, while 90% (n = 36) required PET. PET initiated when CMV VL was ≥ 1000 IU/mL (n = 21) vs when VL < 1000 IU/mL (n = 15) resulted in higher peak CMV VL (12,670 vs. 1284 IU/mL, p = 0.0001) and longer time to CMV DNAemia resolution (36 vs. 24 days, p = 0.035). There were no differences in EOD, OS, or NRM at 12 months post-HCT based on VL at PET initiation.
CONCLUSIONS: Initiating PET when CMV VL was ≥1000 IU/mL resulted in significantly higher peak VL and prolonged DNAemia, with no differences in EOD, OS, or NRM at 12 months post pediatric HCT.