背景:已经发表的数据表明,在异基因造血干细胞移植(allo-HSCT)受者中,巨细胞病毒(CMV)感染与急性移植物抗宿主病(aGvHD)之间存在双向相互作用。这里,我们假设在粪便标本中进行前瞻性CMVDNA监测可能有助于预测随后发生的肠道aGvHD(IaGvHD).
方法:这项双中心研究纳入了121名接受任何方式的allo-HSCT的连续成年患者。共收集了1,009个粪便标本(中位数为7个标本/患者;范围,1-18).使用实时PCR测定进行粪便和血浆中的CMVDNA监测。
结果:在20例患者的粪便中检测到CMVDNA(累积发生率,16.9%;95%CI,6.3%-31.8%)。粪便标本中CMVDNA水平中位数为1,258IU/0.1g(范围,210-4,087IU/0.1g)。所有这些患者和他们的捐赠者都是CMV血清阳性,20例患者中有16例也患有CMVDNA血症,而4例患者在无CMVDNA血症的粪便中检测到CMVDNA。血浆和粪便中的CMVDNA载量之间没有发现相关性(P=0.40)。既往CMVDNA血症,aGvHD,或IaGvHD与粪便中CMVDNA的存在无关。IaGvHD存在于30名患者中,其中5人在粪便中检测到CMVDNA。在粪便和血浆中检测到CMVDNA均与随后的IaGvHD(OR,0.67;95%CI,0.18-2.52;P=.55,OR,0.86;95%CI,0.38-1.96;P=0.71)。在研究期间,该队列中没有患者患有CMV终末器官疾病。
结论:我们的研究未能提供证据表明GICMV感染与IaGvHD之间存在相互作用。粪便中的CMVDNA监测似乎对预测IaGvHD的发生没有价值。
BACKGROUND: Data have been published suggesting a bidirectional interaction between cytomegalovirus (CMV) infection and acute graft-versus-host disease (aGvHD) in allogeneic hematopoietic stem cell transplant (allo-HSCT) recipients. Here, we hypothesized that prospective CMV DNA monitoring in stool specimens may be useful for predicting subsequent occurrence of intestinal aGvHD (IaGvHD).
METHODS: This two-center study enrolled 121 consecutive adult patients undergoing any modality of allo-HSCT. A total of 1,009 stool specimens were collected (a median of 7 specimens/patient; range, 1-18). CMV DNA monitoring in stools and plasma was performed using real-time PCR assays.
RESULTS: CMV DNA was detected in stools in 20 patients (cumulative incidence, 16.9%; 95% CI, 6.3%-31.8%). Median CMV DNA level in stool specimens was 1,258 IU/0.1g (range, 210-4,087 IU/0.1 g). All these patients and their donors were CMV seropositive, and 16 of the 20 patients also had CMV DNAemia, while 4 patients had CMV DNA detected in stools without CMV DNAemia. No correlation was found between CMV DNA loads in plasma and stools (P = .40). Prior CMV DNAemia, aGvHD, or IaGvHD were not associated with presence of CMV DNA in feces. IaGvHD was present in 30 patients, in 5 of whom CMV DNA was detected in stools. Neither detection of CMV DNA in feces nor in plasma was associated with subsequent IaGvHD (OR, 0.67; 95% CI, 0.18-2.52; P = .55 and OR, 0.86; 95% CI, 0.38-1.96; P = .71, respectively). No patient in this cohort had CMV end-organ disease within the study period.
CONCLUSIONS: Our study failed to provide evidence pointing to a reciprocal interaction between GI CMV infection and IaGvHD. CMV DNA monitoring in stools seems of no value to anticipate occurrence of IaGvHD.