Clinical Research Of Cytomegalovirus Infection After Allogeneic Hematopoietic Stem Cell Transplantation

ObjectiveTo Analyze the incidence,risk factors and preemptive therapy efficacy of cytomegalovirus(CMV)infection after allogeneic hematopoietic stem cell transplantation(allo-HSCT);To compare the safety and efficacy of foscarnet and ganciclovir in the prophylaxis of CMV infection after allo-HSCT,providing evidence for its prevention and treatment.Methods1.Clinical data of 165 patients undergoing allo-HSCT in our department from January 2013 to December 2014 were collected.The incidence,risk factors and preemptive therapy efficacy of CMV infection were retrospectively analyzed.2.69 patients receiving allo-HSCT were prospectively chosen in our department from October 2015 to February 2017 as research objects.They were randomly assigned to receive foscarnet or ganciclovir as prophylaxis of CMV infection after hematopoietic reconstitution.Their incidences of CMV infection and side effects were observed during the period of prevention and within 100 days after allo-HSCT.Results1.The infection rate of CMV infection was 39.4%(65/165),the median time of the first CMV viremia was day 45 after allo-HSCT.CMV DNA was cleared in 96.9%(63/65)patients after preemptive therapy.10 patients developed CMV disease(3 with CMV pneumonia and 7 with CMV-related hemorrhagic cystitis).2.The multivariate analysis showed that II-IV acute graft versus host disease(aGVHD),use of anti-thymocyte globulin(ATG)in the conditioning regimen and blood cyclosporine(CSA)concentration >300ng/ml or tacrolimus(FK506)>15ng/ml are the risk factors for CMV viremia.3.In foscarnet group,the incidence of CMV infection during period of prevention,CMV infection and CMV disease within 100 days after allo-HSCT are 11.4% 、 31.4% and 11.4%,respectively.In ganciclovir group,the incidence of CMV infection during period of prevention,CMV infection and CMV disease within 100 days after allo-HSCT are 2.9%,20.6% and 0,respectively.Difference was not statistically significant(P>0.05)in two groups.The time of first CMV infection in patients on ganciclovir was statistically delayed compared those on foscarnet.4.Grade 3 neutropenia(ANC<1.0×109/L)occured more frequently in ganciclovir group(P<0.05),whereas there was no significant difference in the rate of grade 4 neutropenia,grade 1/2 thrombocytopenia.(ANC<0.5×109/L).The incidence of serum elecotrolyte abnormalities were significant more common in foscarnet group than that in ganciclovir group.There was no significant difference in impaired renal function.Drug discontinuation due to adverse events happened in 4 patients of foscarnet group,but in no of ganciclovir group.Conclusion1.CMV infection remains one of the major complications in the recepients after alloHSCT.II-IV acute graft versus host disease(aGVHD),use of anti-thymocyte globulin(ATG)in the conditioning regimen and blood cyclosporine(CSA)concentration >300ng/ml or tacrolimus(FK506)>15ng/ml are the risk factors for CMV viremia.2.The research shows that Foscarnet has similar efficacy with ganciclovir in prophylaxis of CMV infection after allo-HSCT,with the adverse effects of which are different.