| Autor: |
George, B., Kerridge, I.H., Gilroy, N., Huang, G., Hertzberg, M.S., Bradstock, K.F., Gottlieb, D.J. |
| Předmět: |
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| Zdroj: |
Transplant Infectious Disease; Apr2012, Vol. 14 Issue 2, p141-148, 8p, 3 Charts, 2 Graphs |
| Abstrakt: |
Background This retrospective study was aimed at establishing a clinical score to stratify the risk of cytomegalovirus ( CMV) reactivation in patients undergoing allogeneic hematopoietic stem cell transplantation ( HSCT) in order to direct strategies for post-transplant CMV monitoring and therapy. Patients and methods In total, 335 adult patients undergoing HSCT were analyzed and divided into a training set ( n = 235) and a validation set ( n = 100). Logistic regression analysis on the training set identified recipient and donor CMV seropositivity, acute graft-versus-host disease ( GVHD), and use of anti-thymocyte globulin or alemtuzumab as significant risk factors for CMV reactivation. Weighted scores were assigned to each factor. A weighted score ( CMV scoring index [ CSI]) was calculated for each patient using the scores of all risk factors except for GVHD. The index was collapsed into 3 risk groups - low risk (score of 0-2), intermediate risk (score of 3-5), and high risk (score of 6-7) - and reactivation rates were calculated. In the training set, CMV reactivation occurred in 5.8% in the low-risk group, 44.8% in the intermediate-risk group, and 67.7% in the high-risk group. Results In patients with an intermediate CSI only, significantly higher reactivation rates were seen in the presence of corticosteroid treatment for GVHD (57.8% vs. 24.5%, P < 0.01). These findings were similar in the validation set with reactivation rates of 0% in the low-risk, 46% in the intermediate-risk, and 68.4% in the high-risk groups. As seen in the training set, the presence of GVHD was associated with higher CMV reactivation rates only in the intermediate-risk group (64% vs. 28% in the absence of GVHD, P = 0.02). Conclusions Identification of these 3 risk groups in association with the presence or absence of GVHD will help transplant units to make pre-transplant policy decisions about prophylactic, pre-emptive, or experimental CMV prevention strategies in groups of patients undergoing HSCT, as well as in those developing GVHD post transplant. [ABSTRACT FROM AUTHOR] |
| Databáze: |
Complementary Index |
| Externí odkaz: |
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